{"paper_id":"622b2bdc-c800-4963-a0e3-4aa505ce1d7e","body_text":"A B C D E F G S1  \n \n \n \n \nPostgraduate Educational \nProgramme \nCategorical Courses (CC) \nEFOMP Workshop (EF) \nESR meets Sessions (EM) \nEuropean Excellence in Education (E³) \nHonorary Lectures (HL) \nMini Courses (MC) \nMultidisciplinary Sessions (MS) \nNew Horizons Sessions (NH) \nOpening Lecture (OL) \nProfessional Challenges Sessions (PC) \nRefresher Courses (RC) \nRTF - Radiology Trainees Forum (TF) \nSpecial Focus Sessions (SF) \nState of the Art Symposia (SA) \n\u0013\u0013\u0019\"\u001f \u0016\u0014#\u0002\u0001\u0010\u0014\u001f\u0015\u0019\u0019\u0001\n\n\u0001\u0001\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0001\u0001\u0006\u0006\n\u000f\u000f\u001f\u001a\u0016\u0014#\u0002\u0001\u0010\u0014\u001f\u0015\u0019\u0001\u000b\u0001\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0001\u0005\t\n\u0012\u0014!\"\u001f\u0016\u0014#\u0002\u0001\u0010\u0014\u001f\u0015\u0019\u0001\f\u0001\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0001\b\n\u0012\"\u001d\u0016\u0014#\u0002\u0001\u0010\u0014\u001f\u0015\u0019\u0001\r\u0001\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0001\u000b\t\n\u0010\u001e\u001d\u0016\u0014#\u0002\u0001\u0010\u0014\u001f\u0015\u0019\u0001\u0005\u0004\u0001\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0003\u0001\u0005\u0005\u0007\n)NSIGHTSª)MAGINGª\b\u0012\u0010\u0011\u0014\tª\u0015ª\b3UPPLª\u0011\t\u001a3\u0011n3\u0011\u0013\u0013ª\n$/)ª\u0011\u0010\u000e\u0011\u0010\u0010\u0017\u000fS\u0011\u0013\u0012\u0014\u0014\r\u0010\u0011\u0014 \r\u0010\u0013\u0011\u0016\r ª\u0016\n\nA B C D E F G S2  \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n\u0013\u0019\"\u001f \u0016\u0014#\u0002\u0001\u0010\u0014\u001f\u0015\u0019\u0001\n\u0001\n\nA B C D E F G S3  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n12:30 - 13:30 Room E2  \nThe Beauty of Basic Knowledge: Skeletal Radiology  \nMC 26 A  \nPlain radiographs: analysis and \ninterpretation  \nModerator:  \nV.N. Cassar-Pullicino; Oswestry/UK \nA-001 12:30 \nPlain radiographs: analysis and interpretation  \nI. McCall; Devon/UK (mccalli832@btinternet.com) \nThe radiograph remains a quick and inexpensive imaging modality. Factors to \nevaluate include the thickness and outlines of cortical bone, the density and \npattern of trabecular bone and the presence or absence of periosteal new \nbone. The position of lesions within the bone, their outline, size and margin and \nwhether they are single or multiple also provide important diagnostic \ninformation. Adjacent soft tissues are affected by many conditions, particularly \ntrauma and infection and are integral to image interpretation. While MRI is \nessential for internal joint structures, radiographs demonstrate subchondral \nbones, alignment, erosions and surrounding soft tissues. Knowledge of normal \nradiographic anatomy and variants is esse ntial. In trauma, subtle changes in \nbone alignment, discontinuity of bone outline or alteration in density of \ntrabecular bone may indicate injury. Generalised increased or decreased bone \ndensity indicates imbalance in bone creation or loss due to systemic diseases \nand may be difficult to recognise at an early stage, but is recognisable when \nlocalised in comparison to the unaffected bone. Localised reduced density may \nresult from hyperaemia, disuse or from replacement by cysts and sclerotic \nreaction by trauma and infection, while primary and secondary bone tumours \nmay result in either response. Other f eatures including cortical expansion or \nscalloping and marginal bone response internal calcification will refine the \ndiagnosis. Periosteal new bone in differi ng patterns results from local insult or \nmore generalised metabolic and haemodynamic changes, while soft tissue \nswelling, muscle and ligament outline alterations and presence of calcification \nprovide vital clues to disease recognition and diagnosis.  \nLearning Objectives:\n1. To learn about the current role of plain radiographs. \n2. To appreciate the strengths and weaknesses of plain radiographs in \nmusculoskeletal disease. \n3. To understand methods for analysing radiographic abnormalities and an \napproach to their correct interpretation. \n12:30 - 13:30 Room F1  \nThe Beauty of Basic Knowledge: Interventional Radiology  \nMC 25 A  \nNeedles and samples: a practical \napproach to image-guided biopsy  \nModerator:  \nM. Bezzi; Rome/IT \nA-002 12:30 \nNeedles and samples: a practical approach to image-guided biopsy  \nM. Bezzi; Rome/IT (mario.bezzi@uniroma1.it) \nPercutaneous needle biopsy has been a mainstay of oncologic diagnosis for \nalmost three decades, since the advent of ultrasound and CT. The basic \nprinciples of fine-needle aspiration and core needle biopsy can be applied to \nalmost any site in the body, with subtle differences in technique depending on \nthe organ being investigated and the imaging modality utilised. While \nexcisional biopsy is still appropriate in certain cases, percutaneous needle \nbiopsy has become the standard of care in the diagnosis of most tumors \nthroughout the body and is also used to diagnose noncancerous conditions, \nsuch as infection. Percutaneous biopsy is also beneficial in the staging of \npatients with cancer, particularly when another treatment method may be more \nappropriate than surgical resection. The advantages of percutaneous biopsy \nover surgical excisional biopsy incl ude time and cost savings and reduction in \nmorbidity. The aim of this course is to  discuss the practical aspects of biopsy, \nneedle selection, and guidance techniques and to show how to approach \ndifficult lesions and avoid complications.  \nLearning Objectives:\n1. To understand the indications for percutaneous image-guided biopsy. \n2. To learn about the practical aspects of biopsy, needle selection and \nguidance techniques. \n3. To learn how to approach difficult lesions and avoid complications. \n14:00 - 15:30 Room C  \nInteractive Teaching Session  \nE³ 220  \nThe treated breast: what you need to know  \nA-003 14:00 \nA. Imaging after treatment of breast cancer  \nM.H. Fuchsjäger; Graz/AT (michael.fuchsjaeger@medunigraz.at) \nImaging after treatment of breast cancer is for confirmation of lesion removal, \nidentification of postprocedural flui d collections, detection of residual or \nrecurrent cancer and screening for metachronous cancers. Posttherapy \nchanges - which include fluid collections, edema, skin thickening, architectural \ndistortion, scarring and calcifications - are mainly due to surgery, axillary \ndissection and radiotherapy. The greatest treatment-related changes occur 6-\n12 months after therapy, and mammographic stability is achieved after two to \nthree years. For mammography, pre- and all posttherapeutic images have to \nbe compared. Ultrasound is the method of choice for evaluation of fluid \ncollections. MRI is for problem solving (i.e. differentiation between scar and \nrelapse) and should not be performed prior to 12 months after therapy to avoid \nfalse-positive diagnoses. Dystrophic calcifications may develop in areas of fat \nnecrosis mimicking malignancy. Fat necrosis predominantly occurs at the \ntreated site; however, it can develop anywhere in the ipsilateral breast. Its \nappearance may be indistinguishable from cancer at all imaging modalities. To \ndifferentiate between fat necrosis and other common post-treatment changes \nfrom relapse, it is important to know the timeline when these changes occur \nand schedule follow ̻up imaging accordingly. Mammography serves as the \nbasis for postoperative surveillance. Ultrasound is helpful in the early \npostoperative phase, whereas MRI is the method of choice, especially for \ndifferentiation of scar and relapse in the later postoperative phases.  \nLearning Objectives:\n1. To understand common features related to breast surgery. \n2. To recognise changes related to non-surgical treatments. \nA-004 14:45 \nB. Imaging after treatment of benign breast conditions  \nJ. Camps Herrero; Valencia/ES (juliacamps@gmail.com) \nBreast radiologists need to be familiar with post-treatment imaging findings in \npatients with breast cancer, but often patients are also imaged after a \ndiagnosis of benign entities which are treated surgically (fibroadenomas, radial \nscars, papillary lesions) or after a percutaneous diagnosis of a high-risk lesion \nwhich has undergone a surgical biopsy to avoid underestimation (atypical \nductal hyperplasia, lobular neoplasia or flat epithelial atypia). These \nprocedures will leave an imprint on the breast which can be a cause of concern \ndue to the surgical scar. Furthermore, imaging findings after plastic surgery for \nmastopexy, reduction mastoplasties, implants or auxiliary techniques \n(lipofilling, hyaluronic acid) are becoming frequent in our daily practice and \nhave their peculiarities that can overshadow breast cancers. Interventional \npercutaneous procedures can also be a cause of tissue distortion. There are \nadvanced systems for biopsy (BLES) and for percutaneous removal of benign \nlesions (fibroadenomas, papillomas), which use large-gauge needles and have \nto be accounted for due to their trace in the breast tissue.  \nLearning Objectives:\n1. To understand common features related to breast surgery. \n2. To recognise changes related to non-surgical treatments. \nAuthor Disclosure:\n J. Camps Herrero: Advisory Board; Bayer. Speaker; Bayer. \n\nA B C D E F G S4  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n16:00 - 17:30 Room B  \nGI Tract  \nRC 301  \nCross-sectional imaging of colitis  \nA-005 16:00 \nChairman's introduction  \nS.A. Taylor; London/UK (csytaylor@yahoo.co.uk) \nCross-sectional imaging is playing an incre asing role in the diagnosis, staging \nand follow-up of colitis. Often, the radiologist diagnoses colitis on cross-\nsectional imaging, and the clinician requires the most likely diagnosis. \nAlternatively, imaging is used to assess the severity of a known colitis and \nmonitor treatment response. This session will describe state-of-the-art \nprotocols for assessing the inflamed colon using CT, MRI and USS. The \ncommon aetiologies of colitis will then be discussed and tips and tricks as to \nhow to limit the differential diagnosis presented. Finally, the role of cross-\nsectional imaging in the management of inflammatory bowel disease (IBD) will \nbe described with emphasis on disease activity. An integrated approach to \nimaging patients with colonic IBD will be presented.  \nAuthor Disclosure:\n S.A. Taylor: Grant Recipient; NIHR HTA. Other; Study reader for Robarts. \nA-006 16:05 \nA. Which protocol to use?  \nS. Schmidt; Lausanne/CH (sabine.schmidt@chuv.ch) \nThe role of cross-sectional imaging in the diagnosis of colitis is increasing \nfollowing recent technologic advances. Prio r colonic cleansing is usually not \nrequired, unlike in CTC. However, careful attention to the examination \ntechnique is essential, since collaps ed colon may suggest colonic wall \nthickening, thus mimicking colitis. When using CT or MRI, adequate luminal \ndistension is necessary, while this is optional in US where direct compression \nof the bowel aids diagnosis. Recommended imaging protocols will be \ndiscussed. CT remains the workhorse for imaging suspected colitis, especially \nin emergency settings. It is widely available and facilitates rapid data \nacquisition with excellent spatial reso lution. Intravenous contrast medium \nadministration can reveal the typical ta rget sign of colitis, which can easily be \ndifferentiated from other wall patterns, such as diffuse enhancement seen in \ncancer. MRI does not expose patients to radiation and provides excellent \ntissue contrast facilitating the detailed analysis of the inflamed colonic wall. \nBoth conventional and diffusion-wei ghted sequences provide functional non-\ninvasive assessment of the severity of colitis and monitoring of treatment \nresponses, essential in Crohn patients. Colonic US is safe, well tolerated and, \nin general, freely available, although it requires specific operator expertise. It \nsimultaneously provides morphological and functional information. Absent \nperistalsis and wall thickening in acute colitis usually reduce intraluminal air, \nthus facilitating colonic assessment compared to healthy subjects. Akin to CT \nand MRI, the three colonic wall layers are differentiated and pericolonic \nfindings can be assessed. However, US can be limited by the patient's body \nhabit and the radiologist's practical experience.  \nLearning Objectives:\n1. To become familiar with the role of colonic distension prior to imaging of \nsuspected or known colitis. \n2. To understand typical CT, MRI and US protocols. \n3. To learn about the pros and cons of CT, MRI and US. \nA-007 16:28 \nB. Differentiating between the causes of colitis  \nB. Gallix; Montreal, QC/CA (b-gallix@chu-montpellier.fr) \nThe final diagnosis in determining the type  of colitis is based on clinical and \nlaboratory data and colonoscopic and biopsy findings. However, information \nprovided by endoscopy is limited to the mucosal surface. Cross-sectional \nimaging techniques, such as ultrasound, computed tomography, and magnetic \nresonance, are widely used to assess patients with non-specific abdominal \npain and are gaining acceptance for the assessment of patients with suspected \nacute or chronic colitis. Cross-sectional studies are useful, alternative tools not \nonly in the assessment of bowel wall abnormalities, but also for the \nassessment of extraluminal alterations. Di fferentiating between the causes of \ncolitis is based on the location of involvement, extent and appearance of \ncolonic wall thickening, extraluminal changes, and type of complications \nencountered. When chronic inflammatory colitis is suspected, imaging helps to \ndistinguish ulcerative colitis from Crohn's colitis. Infectious types of colitis share \nthe features of wall thickening, pericolonic stranding, and various degrees of \nascites according to the severity of the disease. Pseudomembranous \ncolitisdemonstrates marked wall thickening and, occasionally, skips areas, but \nis associated with broad-spectrum antibiotic treatment or chemotherapy. \nNeutropeniccolitis is characterised by right-sided colonic and ileal involvement, \nwhereas ischaemic colitis is characteri sed by a vascular distribution pattern \nand history. Diverticulitis is a focal, as ymmetric process with fascial thickening \nand inflamed diverticula. The diagnosis of ischaemic colitis is suspected when \nthe distribution of the colon wall invo lvement follows the vasculature. The \nischaemic changes are commonly segmental, especially in the left colon in \nelderly patients.  \nLearning Objectives:\n1. To learn about the most common cause of colitis through cross-sectional \nimaging in both immune-competent and immune-compromised patients. \n2. To become familiar with differentiating infectious, inflammatory, ischaemic \nand autoimmune conditions based on cross-sectional imaging criteria. \n3. To understand the limitations of cross-sectional imaging in differentiating \nbetween its causes. \nA-008 16:51 \nC. The role of cross-sectional imaging in colonic inflammatory bowel \ndisease  \nJ. Rimola; Barcelona/ES (jrimola@clinic.ub.es) \nEndoscopy is currently considered the reference standard for the evaluation of \ncolonic disease activity in patients with inflammatory bowel disease (IBD). \nHowever, it only allows evaluation of the mucosal surface and is not always \ncomplete. It cannot, therefore, help to estimate the depth of involvement of \ntransmural inflammation and extraluminal  complications, both characteristics of \nIBD. An evolving role for cross-sectional imaging in the evaluation of patients \nwith IBD is increasingly recognised, especially in the setting of Crohn's disease \n(CD) since the cross-sectional imaging has been demonstrated to have a high \ndiagnostic accuracy not only for assessing the presence and extension of \nluminal disease, but also for evaluating the CD-related acute or chronic \ncomplications. Available evidence suggests that ultrasound, computed \ntomography and magnetic resonance have similarly high diagnostic accuracy \nin the detection of disease activity, lo cation, severity and complications: in \nparticular, the penetrating and stricturing lesions which are characteristic of \nCD. Thus, the choice of the technique for assessing CD may be influenced by \nlocal availability or expertise. In the case of ulcerative colitis, cross-sectional \nimaging, although less evaluated, may also be helpful in certain circumstances. \nThere is evidence indicating that cross-se ctional imaging is an alternative \nproblem-solving tool to endoscopy whene ver tissue sampling is not required \nand can provide valuable guidance for performing medical and surgical \ntreatment with maximised efficacy and safety. Overall, findings from cross-\nsectional imaging accurately reflect disease activity and provide reliable \ninformation for decision-making and patient care optimisation.  \nLearning Objectives:\n1. To learn about optimised examination protocols for ulcerative colitis and \ncolonic Crohn's disease in the acute, subacute and chronic disease setting. \n2. To become familiar with the criteria for the assessment of disease activity \nthrough CT, MRI and ultrasound. \n3. To learn about an integrated approach to the use of cross-sectional imaging \nin colonic inflammatory bowel disease. \nPanel discussion:  \nThe role of cross-sectional imaging in the diagnosis and follow-up of \ncolitis  \n17:14\n16:00 - 17:30 Room C  \nInteractive Teaching Session  \nE³ 320  \nThe treated liver  \nA-009 16:00 \nA. Imaging of liver transplantation  \nJ.B. Karani; London/UK (johnbkarani@hotmail.com) \nLiver transplantation is the accepted treatment of patients with irreversible liver \ncell failure and some metabolic disorders and in a selected group of patients \nwith hepatocellular carcinomas. Over the last decade, major transplant centres \nhave reported improving survival rates, though during this period they have \ndeveloped more complex surgical techniques, including split-liver, auxiliary and \nlive-related transplantation, and have treated more marginal higher risk \npatients. This successful outcome has been dependent on appropriate \nrecipient selection, robust surgical technique, improvements in \nimmunosuppression and intensive care management and the prompt \nrecognition and treatment of complications. Diagnostic and interventional \nradiology have been core specialties in  achieving the goals of improved graft \nand patient survival. Improvement in surgical techniques has decreased the \n\nA B C D E F G S5  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nmore common vascular and biliary complications, but the newer techniques \npresent differing diagnostic and interventional challenges, particularly in \npaediatric recipients. Developments in MR and MDCT allow many of these \nvascular, biliary and infective complications to be diagnosed non-invasively. \nVascular techniques of angioplasty and stent placement may reverse the \nsequel of graft ischaemia or portal hypertension. MRC allows the diagnosis of \nbiliary strictures that may be treated by dilatation or stent placement. Imaging \nis also important in the diagnosis of recurrent disease and the acquired \ndiseases of prolonged immunosuppression including atypical infections and the \npost-transplant lymphoproliferative disorders (PTLD). This interactive session \nwill present these appearances by case example and provide guidance of the \nappropriate diagnostic and treatment paradigm.  \nLearning Objectives:\n1. To understand the common imaging findings after liver transplantation. \n2. To recognise significant complications following liver transplantation. \nA-010 16:45 \nB. Imaging of treated liver tumours  \nI. Bargellini; Pisa/IT (irenebargellini@hotmail.com) \nImaging findings after systemic and loco-regional treatments vary greatly \ndepending on baseline features of the treated tumour and treatment modality. \nConventional uni-dimensional and bi-dimensional criteria (such as RECIST 1.1 \nand WHO criteria) have been extensively validated in metastatic lesions \ntreated with conventional chemotherapy. However, their prognostic value is \nlimited in patients treated with new molecular targeted therapies and after loco-\nregional treatments. In the setting of hepatocellular carcinoma (HCC), specific \nresponse criteria (such as EASL and mRECIST) have been proposed that take \ninto account variation in the size of the viable tumour. These criteria have been \nextensively validated, although their in terpretation could be troublesome after \nsome specific treatments, such as molecular targeted agents and Y90-\nradioembolisation. On the other hand, there is no consensus regarding tumour \nresponse criteria for metastatic lesions after loco-regional treatments. The role \nof morphological criteria and several imaging biomarkers (such as those \nprovided by diffusion and perfusion imagi ng, FDG activity, dual source CT) is \nunder investigation, being able to provide additional information on tumour \nactivity and biology. While new drugs with different mechanisms of action and \nnew treatments are becoming available, the work of radiologists is changing \nand there is increasing evidence that tailo red radiological response criteria are \nrequired for these new targeted and tailored treatments.  \nLearning Objectives:\n1. To understand the common imaging findings after chemotherapy for liver \ntumours. \n2. To recognise common imaging findings after radiofrequency ablation of liver \ntumours. \n3. To be aware of the common imaging findings following transarterial \ntreatment of liver tumours. \n16:00 - 17:30 Room D  \nChest  \nRC 304  \nPulmonary vasculitis and systemic \ndiseases  \nModerator:  \nA. Persson; Linköping/SE \nA-011 16:00 \nA. Pulmonary manifestations of systemic diseases  \nC. Engelke; Göttingen/DE \n\"No abstract submitted\" \nLearning Objectives:\n1. To learn about the different systemic diseases that affect the lung. \n2. To become familiar with pulmonary abnormalities due to systemic disease. \nA-012 16:22 \nB. Large-vessel vasculitis  \nJ. Vilar; Valencia/ES (vilarsamper@gmail.com) \nPulmonary vasculitides are a challenge for radiologists for two reasons: \nvasculitides are rare diseases and at the same time the pathologic and \nradiological manifestations are very diverse. Primary vasculitides present with \ndifferent clinical scenarios and often confusing situations that mimic other \ndiseases. By definition, vasculitides ar e disorders affecting the blood vessels \nthat may be primary or secondary. Classification of vasculitis according to the \nvessel size is practical, since it is related to the pathological changes as well as \nto the clinical and radiological presentation. The two main large vessel \nvasculitides are giant cell arteritis and Takayasu arteritis. Behcet disease may \ncombine large and small vessel vasculitis. Imaging plays an important role in \nprimary vasculitis. Chest radiographs are not especially useful in large vessel \nvasculitis. Contrast CT and MRI further detect and especially help in the \ncharacterisation of large vessel vasculitis. Vessel wall changes are well \ndetected with both techniques. Contrast enhancement, distribution of vessel \ninvolvement and morphological vascular changes should be considered. \nToday, PET/CT is the recommended imaging technique in the assessment of \nvessel wall inflammatory changes and in the evaluation of treatment response. \nAlthough the clinical scenario differs us ually between Takayasu and giant cell \narteritis, the radiologist should combine the imaging findings with clinical and \nlaboratory data to suspect a specific vascu litis. Therefore, this presentation will \nconcentrate on the basic signs and associated findings in large vessel \nvasculitis, pathologic correlation, imagi ng protocols and the differential \ndiagnosis.  \nLearning Objectives:\n1. To learn about the different types of large-vessel vasculitis. \n2. To become familiar with histopathological correlates in vasculitis. \n3. To appreciate the different manifestations and imaging appearances of \nlarge-vessel thoracic vasculitis. \nA-013 16:44 \nC. HRCT patterns in pulmonary vasculitis  \nC.M. Schaefer-Prokop; Amersfoort/NL (cornelia.schaeferprokop@gmail.com) \nThe term vasculitis refers to a variety of clinico-pathological entities. The most \nwidely used Chapel-Hill classification divides the vasculitis syndromes into \nthree groups based on the size of vessels primarily involved. Small vessel \nvasculitis such as ANCA- associated granulomatous vasculitis (Wegener's \ndisease), Churg-Strauss granulomatosis and microscopic polyangitis are most \noften associated with pulmonary abnormalities. The spectrum of HRCT findings \nis quite variable and differs by entity. The HRCT findings will be discussed \ntogether with clinical and laboratory findings to be integrated into a \nmultidisciplinary diagnostic approach.  The typical findings in Wegener's \ngranulomatosis include solitary or multiple, often cavitary nodules or masses, \nor focal or diffuse consolidations, Churg Strauss is dominated by interlobular \nthickening or transient multifocal and nonsegmental consolidations frequently \nin subpleural distribution. All types of pulmonary vasculitis may present with \nfocal or diffuse pulmonary haemorrhage that produces pulmonary ground glass \nor consolidations in various distributions. A number of collagen vascular \ndiseases (e.g., lupus erythematosus) or other granulomatous diseases (e.g. \nsarcoidosis) may affect the small pulmonary vessels causing haemorrhage or \npulmonary hypertension. Per disease entity, the course will review typical and \nmore rare HRCT features and key features that allow for diagnosis and \nclassification, discuss side-to-side overl apping of morphologic features \nimportant for differential diagnosis and illustrate the findings of other diseases \nthat represent the most challenging differential diagnosis, e.g. oedema, \ninfection or malignant diseases.  \nLearning Objectives:\n1. To learn when HRCT is of value in investigating pulmonary vasculitis. \n2. To appreciate the different appearances of pulmonary vasculitis on HRCT. \nA-014 17:07 \nD. Inflammation and remodeling  \nA.A. Bankier; Boston, MA/US (abankier@bidmc.harvard.edu) \nThe presentation will lay out the pathological and pathophysiological basis for \nthe complex processes of inflammation and remodelling. The implications of \nthese processes for imaging will be discussed and illustrated by selected \npathologies. Finally, the presentation will indicate how the imaging reflections \nof these processes could be used in the future as imaging biomarkers for the \ndiagnosis, follow-up, and outcome evaluation of disease.  \nLearning Objectives:\n1. To learn about the different causes of pulmonary inflammation. \n2. To understand how the lung responds to inflammation. \n3. To become familiar with pulmonary changes following inflammation. \nAuthor Disclosure:\n A.A. Bankier: Author; Elsevier. Consultant; Olympus. Research/Grant \nSupport; NIH. Speaker; ATS. \n\nA B C D E F G S6  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n16:00 - 17:30 Board Room B  \nCardiac  \nRC 303  \nHybrid cardiovascular imaging: where \nshould we go?  \nModerator:  \nK. Gruszczynska; Katowice/PL \nA-015 16:00 \nA. PET/CT: present state and future prospects  \nM. Schwaiger; Munich/DE (markus.schwaiger@tum.de) \nMultimodal cardiac imaging with PET/CT has gained increasing clinical \nacceptance, since the combination of structural definition of coronary anatomy \nas well as quantification of regional myocardial perfusion allows very \ncomprehensive workup of patients with suspected coronary artery disease. \nIndependently of detection of coronary art ery disease the quantification of \nregional and global myocardial perfusion has to be shown of prognostic value. \nThe combination of extent of coronary artery disease as well as restriction of \nmacro and micro circulation provides an integrative measure of the ischemic \nburden to patients with known or suspected coronary artery disease. The \ndiagnostic and prognostic value of this combined PET/CT approach competes \nsuccessfully with invasive diagnostic workup. However, there are no \nprospective randomised studies to document the relative value of invasive vs \nnon-invasive strategies in the workup of patients with coronary artery disease, \nwhich has to be related to patient workup.  \nLearning Objectives:\n1. To become aware of the present state of PET/CT in cardiovascular imaging. \n2. To become familiar with appropriate indications for PET/CT studies of the \nheart. \n3. To learn about technical innovations in PET/CT imaging. \nAuthor Disclosure:\n M. Schwaiger: Consultant; Navidea. Research/Grant Support; Siemens PET. \nA-016 16:30 \nB. SPECT/CT: is it just PET/CT's little brother?  \nM. Hacker; Vienna/AT (marcus.hacker@meduniwien.ac.at) \nAppropriate diagnosis and therapy of coronary artery disease (CAD) frequently \nrequire information about both the morphological and functional status of the \ncoronary artery tree. Thus, combined imaging consisting of invasive coronary \nangiography (ICA) plus SPECT myocardial perfusion imaging (MPI) is \npracticed in clinical routine diagnostic of  patients with stable angina since many \nyears and can therefore be accepted as the reference standard in the \ndiagnosis of hemodynamically relevant coronary artery stenoses. Both \nmorphological and functional informati on are mandatory for the decision of \nperforming an interventional therapy or initiating/maintaining medical treatment \nin numerous symptomatic patients. The hemodynamically relevance of \ncoronary artery lesions is a major condition to decide whether an interventional \ntherapy should be performed or not. A non-invasive concept providing both \ninformation could provide accurate allocation of perfusion defects to their \ndetermining coronary lesion and specific morphological and functional \nclassification of patients with coronary artery disease. In symptomatic patients, \na normal stress MPI confers a very low short-term risk for cardiac death and/or \nacute myocardial infarction. However, a normal MPI does not exclude the \npresence of underlying coronary atherosclerosis, which may be extensive \nalthough not yet flow-limiting. In this regard, CT will unmask a sizeable \nsubgroup of patients with coronary atherosclerosis who should receive more \nintensive antiatherosclerotic intervention than would have been indicated by \nMPI results alone. Knowledge regarding the presence and extent of subclinical \ncoronary atherosclerosis in patients who do not have ischemia by MPI can be \nof importance in patient management.  \nLearning Objectives:\n1. To appreciate the scope of information a SPECT/CT cardiac study can \ndeliver. \n2. To become familiar with protocols of SPECT/CT studies. \n3. To learn a structured approach to performing and reporting a SPECT/CT \nstudy. \nA-017 17:00 \nC. MR/PET: do we really need it?  \nH.H. Quick; Erlangen/DE (Harald.Quick@imp.uni-erlangen.de) \nFollowing PET/CT and SPECT/CT, MR/PET hybrid imaging is the most recent \naddition to the palette of hybrid imaging modalities. MR/PET synergistically \ncombines the excellent soft tissue contrast and detailed image resolution of \nMR with metabolic information provided by PET. Integrated MR/PET systems \nfurthermore offer the ability to acquire hybrid imaging data simultaneously. This \ncan be applied to MR-based motion correction of PET data. These features \nopen up several cardiac applications, e.g. evaluation of cardiac function and \nviability, diagnosis of cardiac inflammatory diseases and tumorous diseases. \nTo fully assess the diagnostic potential of MR/PET, however, several technical \nchallenges have to be considered: attenuation correction (AC) of the patient \ntissues in MR/PET has to be based on MR-images and is currently hampered \nby a limited number of tissue classes and undercorrection of bone tissue. \nCardiac radiofrequency coils and ECG gating equipment are currently not \nconsidered in AC. Consequently, quantification of PET data therefore might be \nbiased. The clinical workflow is rat her complex and needs to be tailored to \ncardiac examinations. Few research groups currently explore this new hybrid \nimaging modality in selected cardiac applications. Cardiac MR/PET: Do we \nreally need it? Considering the sparse clinical experience that is available \ntoday, it is quite early to answer this question yet. However, once the \nremaining technical hurdles are overco me and the diagnostic potential can be \nfully exploited clinically, the answer is most likely positive.  \nLearning Objectives:\n1. To learn about technical requirements for performing cardiac PET/MRI \nstudies. \n2. To learn if cardiac PET/MRI can be successfully performed in clinical \nroutine. \n3. To become familiar with the principal advantages/disadvantages of PET/MRI \ncompared to other hybrid imaging technologies. \nAuthor Disclosure:\n H.H. Quick: Equipment Support Recipient; The Biograph mMR sytsem at the \nInstitute of Medical Physics, Erlangen, was funded by a research agreement \nbetween the University of Erlangen and Siemens AG, Healthcare Sector, \nErlangen. \n16:00 - 17:30 Room E1  \nMolecular Imaging  \nRC 306  \nFunctional and multimodality \nneuroimaging\nModerator:  \nO. Clément; Paris/FR \nA-018 16:00 \nA. Clinical applications of PET/CT in neurology  \nA.H. Jacobs; Münster/DE \nPositron Emission Tomography (PET) is being used together with various \nradiotracers to investigate alterations of me tabolism and neurotransmission in \nvarious neurological diseases. Target stru ctures for PET imaging comprise \nneurons (e.g. glucose or oxygen consumption; enzyme activity; receptor \ndensity); glial and endothelial aminoacid transporters; microglial function; and \ninterstitial protein deposits. Together with MRI, PET helps to delineate (i) the \npenumbra in stroke; (ii) inflammatory activity in multiple sclerosis; (iii) \nepileptogenic foci in epilepsy; (iv) protein deposits and altered glucose \nconsumption in Alzheimer‘s disease; (v) altered dopaminergic transmission in \nParkinson‘s disease; and (vi) increased uptake of radiolabeled amino acids in \ngliomas. The lecture will outline the additional value of PET/CT imaging in the \nvarious most common neurological diseases to specifically increase the \ndiagnostic accuracy and to help in the establishment of imaging-guided therapy \nparadigms. In addition, an outlook will be given from the clinical research \nprogramme of the 7th FW EU INMiND project (Imaging Neuroinflammation in \nNeurodegenerative Diseases; http://www.uni-muenster.de/InMind/). \nLearning Objectives:\n1. To become familiar with the role of PET/CT in neurology. \n2. To learn about radiotracers that can be used in neuroimaging. \n3. To understand PET/CT applications in relationship to disease presentations. \nAuthor Disclosure: \nA.H. Jacobs: Grant Recipient; 7th FW EU Programme QuicConcept and \nINMIND \n\nA B C D E F G S7  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-019 16:30 \nB. MR/PET changes and challenges  \nB.J. Pichler; Tübingen/DE \n\"No abstract submitted\" \nLearning Objectives:\n1. To understand the fundamentals of MR physics relevant to MR/PET \nimaging. \n2. To appreciate the advantages of MR/PET and its complementary role in \ndiagnostic neuroimaging. \n3. To learn about the benefits and challenges of combined MR/PET. \nA-020 17:00 \nC. Advanced MR neuroimaging techniques  \nM. Smits; Rotterdam/NL (marion.smits@erasmusmc.nl) \nFunctional MR imaging (fMRI) and diffusion tensor imaging (DTI) are used \nextensively in the research arena to study an infinite number of questions \nregarding the brain's function and structure under normal conditions, as well as \nwith neurological and psychiatric disease. The clinical use of these techniques, \nhowever, is by comparison fairly limited. The current main indication is the \npresurgical assessment of the relationship between the brain tissue to be \nresected and functionally eloquent brain tissue. In the context of brain tumour \nsurgery, the aim is maximum tumour resection, while at the same time avoiding \nfunctional deficit. With tumour localisation in or near presumed eloquent brain \nareas, such as the motor or language areas, additional fMRI and DTI may be \nadvantageous to guide the neurosurgical approach, shorten surgery duration \nand obtain prognostic information prior to surgery. fMRI is used to localise \neloquent cortex, which is particularly useful when normal anatomy is obscured \nby tumour mass effect or in cases of cortical plasticity. With DTI the anatomy \nand involvement of white matter tracts may be evaluated. Inadvertent \ntransection of white matter tracts during surgery leads to severe neurological \ndeficit. DTI-tractography offers attractive visualisation of the major white matter \ntracts, such as the corticospinal tract and the arcuate fasciculus, and offers \nvaluable preoperative information on their relationships with the brain tumour to \nbe resected. As well as providing such anatomical information, colour-coded \neigenvector maps obtained with DTI can be used to categorise involvement of \nthe white matter tracts by brain tumour.  \nLearning Objectives:\n1. To learn about functional MR imaging (fMRI) and diffusion tensor imaging \n(DTI). \n2. To understand the application of these techniques in the study of the healthy \nand diseased human brain. \n3. To learn about the brain's activity and its connections. \n16:00 - 17:30 Room E2  \nMultidisciplinary Session: Managing Patients with Cancer  \nMS 3\nMultidisciplinary approach for detection \nand treatment of malignant primary bone \ntumours\nA-021 \n16:00 \nChairman's introduction  \nK. Verstraete; Ghent/BE (koenraad.verstraete@ugent.be) \nMalignant bone tumours are rare and have poor prognosis, unless a \nmultidisciplinary approach is applied. First, the radiologist plays an important \nrole in diagnosis, staging and treatment follow-up of bone tumours. Plain \nradiography and routine and dynamic contrast-enhanced MRI are the most \nimportant imaging techniques. In this session, we will focus on osteosarcoma \nand Ewing sarcoma. Once the diagnosis is proven by biopsy, neoadjuvant \nchemotherapy will be given by the oncologist during a preoperative period of \nabout 3 months. Then, a new MR study is required for preoperative staging \nand assessment of response. Whenever possible, a limb-saving surgery will be \nperformed, preferably by a dedicated oncologic surgeon, in a referral centre for \nbone tumours. After surgery, tumour response will be measured by the \npathologist, and adjuvant chemotherapy will be given for about one more year. \nClose follow-up by the multidisciplinary team is required for 5 more years. Two \ncase presentations will illustrate how t he multidisciplinary approach works and \nclarify the role of the radiologist, oncologist and oncologic surgeon.  \nSession Objectives: \n1. To learn about the task of the radiologist in diagnosis, staging and treatment \nfollow-up of bone tumours. \n2. To understand the oncologic and surgical treatment of bone tumours. \n3. To become familiar with the multidisciplinary approach to diagnosis staging \nand treatment of bone tumours. \nA-022 16:05 \nImaging malignant primary bone tumours  \nK. Verstraete; Ghent/BE (koenraad.verstraete@ugent.be) \nThe majority of malignant bone tumours can be detected on plain radiography. \nThe age of the patient, location of the tumour in a bone and history of a pre-\nexisting bone abnormality should be included in determining the likely \ndiagnosis. Careful analysis of the pattern of bone destruction, periosteal \nreaction and matrix mineralisation allow for characterisation of most cases of \nosteosarcoma, Ewing's sarcoma, chondrosarcoma and adamantinoma. MRI is \nthe best imaging technique for staging by displaying 1. the extent of bone \nmarrow involvement, including epiphyseal infiltration and skip lesions, 2. the \npresence and extent of extraosseous soft tissue mass, 3. involvement of the \nneurovascular bundle, muscle compartments and adjacent joint. This allows to \nfind the best biopsy approach and establish the feasibility of limb salvage as \nopposed to amputation. Longitudinal non-contrast T1 sequences are the most \naccurate for determining intraosseous extent. Axial fat-suppressed PD or T2 \nsequences optimally demonstrate soft tissue extension, and dynamic contrast-\nenhanced MRI is useful for differentiation of extraosseous tumour from edema \nand for assessment of tumour response to chemotherapy. Chest CT is the \nmost sensitive modality for detection of pulmonary metastases, and technetium \nskeletal scintigraphy is still frequently used for detection of osseous \nmetastases. The most valuable, readily available and easy-to-use techniques \nto assess response to radiation therapy and chemotherapy are dynamic \ncontrast-enhanced MR imaging, diffusion MRI and colour-Doppler ultrasound. \nTo evaluate local control of disease and for detection of local recurrence, MRI \nis usually the best imaging technique. Plain radiography may detect \ncomplications of prosthesis.  \nLearning Objectives:\n1. To consolidate knowledge on malignant primary bone tumors on plain \nradiography, CT and MRI. \n2. To understand the principles of tumour staging and monitoring \nchemotherapy. \n3. To become familiar with imaging findings following chemotherapy and \nsurgery. \nA-023 16:25 \nOncologic approach to malignant primary bone tumours  \nC. Dhooge; Ghent/BE (Catharina.Dhooge@UGent.be) \nThe most common bone sarcomas are osteosarcoma (OS) and Ewing \nsarcoma. OS occurs primarily in long bones, Ewing sarcoma occurs also in the \npelvis, spine or chest wall. Localised disease confers a 65% cure rate, and \ninitially metastatic disease 25%. A multid isciplinary approach which includes \nneo-adjuvant systemic chemotherapy and local control measures for primary \nand metastatic sites followed by adjuvant chemotherapy has become the \nstandard of care. Complete surgical excision is mandatory in OS; in Ewing, \nradiation can also be used. Standard chemotherapy for OS is based on a \ncombination of cisplatin, doxorubici n and high-dose methotrexate. Ifosfamide \nand etoposide will be further considered (EURAMOS). Systemic therapy for \nEwing includes vincristine, doxoribicin, cyclofosfamide, ifosfamide and \netoposide. High-dose chemotherapy with autologous stem cell reinfusion is \nevaluated in intermediate prognosis and metastatic disease (euro-EWING). \nAmong the different prognostic factors, response to neo-adjuvant \nchemotherapy by measuring chemotherapy-induced necrosis is a powerful \nindicator of outcome in bone sarcomas. Patients who achieve a good \nhistological response to pre-operative chemotherapy, defined as < 10% viable \ntumour at the time of tumour resection, have a better survival than those who \nshow poor response ( >= 10% viable tumour). Five-year survival for good \nresponders is 7O-75% compared to 45-50% for poor responders. However, the \noutcome for malignant bone tumours has improved little in the last 25 years. \nLarge international studies exploring new drugs such as biologic agents \n(interferon) or mechanisms conferring drug resistance (topoisomerase \ninhibitors) in randomised controlled trials will hopefully lead to therapeutic \ninnovation.  \nLearning Objectives:\n1. To become familiar with the principles of chemotherapy in malignant primary \nbone tumours. \n2. To understand what the oncologist expects from the radiologist. \n3. To recognise the value and limits of chemotherapy in malignant primary \nbone tumours. \n\nA B C D E F G S8  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-024 16:45 \nSurgical approach of malignant primary bone tumours  \nG.M.L. Sys; Ghent/BE (Gwen.Sys@UGent.be) \nIn primary malignant bone tumours, three surgical procedures are necessary: \nbiopsy, resection and reconstruction. Whether a biopsy is performed in an \nopen or a percutaneous way is a matter of preference, but in each case it \nshould provide sufficient and representative material for pathological \ninvestigation without compromising the following treatment. The area of \ninterest and the trajectory should be determined preoperatively in a \nmultidisciplinary meeting. As the biops y tract has to be removed during the \nresection surgery, it should be close to the planned approach for the \nsubsequent resection. If a biopsy is performed improperly, the diagnosis may \nbe wrong or the following resection may be impaired because of extensive \ncontamination of compartments, resulting in  a severe functional deficit. Surgery \nplanning is based on clear imaging and a multidisciplinary discussion of tumour \nextension, aiming for a wide resection of the tumour with clear margins. Correct \nperioperative measurements are based on predefined fixed bony landmarks \nthat should preferably be visible on the same image as the tumour. An \namputation is performed if a surgical limb-salvage procedure is expected to \nresult in a non-functional limb. Nowadays, several reconstruction techniques \nfor bones (bone grafts or prostheses), tendons (artificial or human ligaments) \nand skin (skin flaps or grafts) are available. Invasion of the soft tissues such as \nthe neurovascular structures, muscles and skin, will determine which \nreconstruction technique (s) are necessary to restore the patient's function. \nEach reconstruction technique bears inherent complications requiring a regular \nfollow-up.  \nLearning Objectives:\n1. To become familiar with the basic principles of oncologic surgery in \nmalignant primary bone tumours. \n2. To understand what the surgeon expects from the radiologist. \n3. To recognise the value and limits of limb-saving surgery. \nCase presentation and discussion  \n17:05\n16:00 - 17:30 Room F1  \nProfessional Challenges Session  \nPC 3\nRadiology: opportunities and threats  \nA-025 16:00 \nChairman's introduction  \nJ.A. Reekers; Amsterdam/NL (j.a.reekers@amc.uva.nl) \nWe outline the current opportunities and threats in diagnostic radiology: \nTraditional diagnostic radiology has been rapidly replaced by clinical radiology \nand the role of the radiologist is changing from image interpreter to clinical \nmanager of imaging data. To care for the patient`s medical problem and not \nonly his images is important. This contains great opportunities for radiology to \ndevelop and for the radiologist to become a central player in patient \nmanagement. However, this requires not only clinical knowledge and \ninvolvement, but also visibility and sometimes even 24/7 availability. The need \nfor \" only\" image reporting is declining as c linical subspecialisation easily brings \nimage interpretation into the domain of non-radiologists. To understand the \nimportance of identity, visibility is very important. Visibility can be achieved by \nbeing part of MDT s and also in many other ways. Clinical radiology is an idea \nwhich, after all these years, has not been very well embedded in current \nradiology and radiology training. To understand the importance of certified \ntraining, maybe the most important action we have to undertake now is to \ncapitalise on our radiological expertise. Image interpretation in a clinical \ncontext can only be done or franchised (to non-radiologist) under conditions of \ncertification and accreditation by radiol ogy. We should never let the primate of \neducation and certification slip to non- radiologists. Radi ology certification \nshould be a quality standard, recognised by  international and national medical \nbodies, such as medical chambers and specialist societies. The latter should \nhave high priority.  \nSession Objectives: \n1. To learn about the current opportunities and threats in diagnostic radiology. \n2. To understand the importance of identity. \n3. To acknowledge the importance of certified training. \nA-026 16:05 \nWhere are the turf battles in diagnostic imaging?  \nG.M. Bongartz; Basle/CH (georg.bongartz@usb.ch) \nTurf battles in radiology are a foreseeable development for most imaging \ntechniques which evolve push-button methods and readily interpretable \nimaging results. We as radiologists mu st learn to accept competition. Turfs \nshould rather be seen as challenge than as threat. Predominantly, non-\nirradiating techniques like ultrasound and MRI have become progressively \neasier to apply (US) or to understand (MRI), where the final image in some \nstandardised areas (eg joints) can readily be interpreted by medical specialists \nin this field. But also x-ray diagnostics in  dental medicine or orthopedic imaging \nis largely applied outside the radiologic department. CT today seems still \nrelatively excluded because of its complexity. But with increasing resolution, \noptimal 3D reconstruction and fast accessibility, it is only a question of time \nwhen the added value of the radiologist will be under question. Radiology has \nchanged. We must become experts with respect to patho-anatomy and \nradiological differential diagnosis. This requires profound education, both initial \ntraining and ongoing education. Radiology must be advertised internally and \nexternally. In radiological publications, outcome studies are still \nunderrepresented. Demonstration of our dedicated skills, fostering our special \nexpertise and offering this as support to our medical colleagues will preserve \nradiology for the future. Cooperation with partners seems the only way out of a \nturf battle - we need to search for alliances and integrate our partners to create \na win-win situation.  \nLearning Objectives:\n1. To know about turf battles with clinicians around imaging. \n2. To learn which imaging modalities are most at risk. \n3. To learn how to create win-win situations. \nAuthor Disclosure:\n G.M. Bongartz: Research/Grant Support; Siemens Medical Systems \nGermany, Bayer, Switzerland. \nA-027 16:23 \nBeating threats in Europe with radiological training  \nA.K. Dixon; Cambridge/UK (akd15@radiol.cam.ac.uk) \nBy introducing radiology to medical students, it is hoped that they will begin to \nappreciate how difficult it is! Likewise, when teaching residents, they must \ncome to understand the basic anatomy and principles better than their clinical \ncolleagues; this is very much the tenet of subspecialty training. They should \nalso appreciate that patient care is opti mal when there is close collaboration \nbetween clinicians and radiologists. Pa ssing of an examination (national or \nEDiR) offers some proof that a radiologist has attained a certain standard, but \nthe principle of testing oneself formally or informally at regular intervals again \nprovides a measure of continuing competence. Such certification can be of \nvalue in the case of litigation. Radiology is one of the fastest growing \nspecialties and the techniques that we learn during training are quickly \noutdated; hence, the need for life-long learning and effective continuing \nprofessional development.  \nLearning Objectives:\n1. To understand how to teach radiology to undergraduate medical students. \n2. To become familiar with the principles of self-assessment. \n3. To appreciate the necessity for life-long learning. \nA-028 16:41 \nHistory of ultrasound in radiology: lessons learned  \nL.E. Derchi; Genoa/IT (derchi@unige.it) \nThe relationship between radiology and US has never been an easy love story, \nand still isn't. In the early 1970s this new imaging field was not readily covered \nby radiologists and many other colleagues established US sections within their \ndepartments. Then, important fields of US (cardiology, obstetrics, gynecology) \nbecame almost exclusive domain of non-radiologists. In the 1980s, the \nincreasing success of US initiated turf battles with other clinicians. Nowadays, \nclinical specialists perform > 50% of US examinations wordwide. In Europe, \nmost in-hospital US examinations is still performed in radiology, but this is not \nthe case in all countries. A strong practice in US is quite important since this is \noften the first approach to patients. If initial US referrals are kept, radiologists \nwill continue to guide decisions in subsequent imaging workup. Furthermore, \nUS keeps close to patients; in Europe the examination is usually done directly \nby radiologists or, if by sonographe rs, the radiologist usually checks the case \nwith limited directed US imaging. This clearly shows our role as physicians. To \nmaintain a key role in US radiologists need to: 1) Have the best specialists in \nUS; attention must be given to US in residency programs. 2) Invest in US \ntechnology (as examples: CEUS, elastography, 3D/4D). 3) Invest in US \nresearch. 4) Have high visibility in the US community, keeping close contact \nwith all clinical colleagues. 5) Present higher visibility of US within radiology, \nwith leaders supporting US within the radiological community and each \nradiologist promoting US in his/her environment.  \nLearning Objectives:\n1. To understand why ultrasound has moved out of the hands of radiology in \nsome subspecialties. \n2. To learn what this means for daily radiology practice and the quality of work. \n3. To know about the threats and how we should deal with them. \n\nA B C D E F G S9  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-029 16:59 \nInterdisciplinary cooperation without losing identity  \nM.F. Reiser; Munich/DE \nRecently, major shifts in the paradigms of patient care took place: \ninterdisciplinary counseling and including the patient in the decision making \nprocess for diagnostic and therapeutic measures. The new concept is that the \npatient no longer comes to the specialist, but the specialists come jointly to the \npatient. This is reinforced by the competition among health care providers, \npolitical decision makers and the public. In many hospitals this general trend \nhas resulted in the establishment of various centers and boards such as the \nbreast cancer centers, vascular centers and tumor boards for several cancer \nentities to name only few. At the university hospital of Munich 46 centers and \nboards have been implemented up to now. In almost all of them the \nparticipation of radiologists is  required. This results in a major challenge in \nterms of personal resources. Together with the regular clinical-radiological \nrounds the time necessary for these activi ties equals 2 full-time radiologist \nposts. The participation of radiolog ists has many beneficial aspects: \nAcknowledgement of radiology as an important clinical discipline and of the \nradiologist as a clinical consultant; parti cipation in and influence on the \ncreations of SOPs and (internal) guidelines; opportunity to advocate \nappropriate radiological methods for diagnosis and interventions; increase of \nknowledge in clinical medicine and new concepts of therapy; close personal \nlinks with our clinical partners. In order to prevent radiologists from losing their \nidentity as radiologists it is mandatory that they remain firmly integrated in the \nradiology department and to strengthen the position of radiology as the central \ninstitution for providing cost-effective imaging and interventional services. \nMoreover it must be taken care to offer attractive career options within the field \nof radiology.  \nLearning Objectives:\n1. To appreciate how radiologists can work closely with clinicians without losing \ntheir identity. \n2. To understand what the pitfalls and threats are and how we should deal with \nthem. \n3. To learn the central role of radiologists in clinical management of patient \ncare. \nPanel discussion:  \nHow to stay in the driver's seat as radiologist 2.0?  \n17:17\n16:00 - 17:30 Room F2  \nBreast  \nRC 302  \nBreast ultrasound  \nModerator:  \nM. Müller-Schimpfle; Frankfurt a. Main/DE \nA-030 16:00 \nA. Physics and practical aspects of high-quality hand-held US and \nautomated breast US  \nM.H. Fuchsjäger; Graz/AT (michael.fuchsjaeger@medunigraz.at) \nUltrasound (US) is the adjunct method of choice to mammography in breast \nimaging. Over the past two decades, US technology has undergone profound \nadvancements and refinements. US has, therefore, become an assessment \ntool with a defined field of indications as well as a unique set of diagnostic \ndescriptors for breast lesion differentiation. The ACRIN 6666 study has \ndemonstrated the special benefit of US in patients at risk with dense breast \ntissue. The BI-RADS Lexicon for Ultrasound, in its second edition, expanded \nthe role of breast US. Further enhancement of image quality as well as the \nrecent advent of automated breast US has even fueled scientific discussions \non the potential role of US for breast cancer screening. Automated breast US, \nwhich is based on computed generation of a 3D imaging data set obtained \nfrom many parallel 2D images, offers a different approach with a variety of \nbenefits. Images are obtained by the sonographer in standardised fashion, \nwhole breast data sets can be reviewed at any time after the examination, \nreducing operator dependence, and image fusion with, i.e. MRI is easily \npossible. The basic physical background, the significance as well as important \naspects of practical use of handheld and automated breast US will be \nexplained and illustrated by the respective imaging examples. Emphasis will be \nlaid on strengths and potential weaknesses of both US technologies with \nregard to breast imaging.  \nLearning Objectives:\n1. To understand the physics of hand-held US and whole breast US. \n2. To become familiar with the practical techniques of hand-held US and whole \nbreast US. \n3. To appreciate the clinical applications of hand-held US and whole breast \nUS, including automated screening. \nA-031 16:30 \nB. Complicated cysts and complex-cystic lesions: differentiation and \nmanagement  \nC.F. Weismann; Salzburg/AT (christian.weismann@inode.at) \nThe terms \"complicated cyst\" and \"complex-cystic lesion\" are based on breast \nultrasound (US) terminology. The simple cyst is a fluid-filled, clearly defined, \nanechoic lesion without any suspicion of a solid intracystic mass. If a simple \ncyst is complicated by echogenic fluid, it is called complicated cyst. This \nechogenic fluid can be caused, e. g., by cell debris. Thin echogenic septa are \ncommon in complicated cysts. Vascularisation can never be found in these \nechogenic components. A complicated cyst has no solid component and no \nthickened wall or thickened septa. The expected probability of malignancy is \n2%. The US criteria of a complex-cystic lesion following Berg et al. categorise it \ninto 4 types: type 1, thick outer wall and thick internal septa (alone or in \ncombination of both); type 2, one or more intracystic masses; type 3, mass of \nmixed cystic and solid components (at least 50% cystic); type 4, predominantly \nsolid with eccentric cystic foci (at least 50% solid). Complex means there is a \nsuspicion of a tumour inside a cyst or a solid tumour with cystic components. A \ncomplicated cyst will usually be followed by US after 6 months. A complex-\ncystic lesion needs a correlation with mammography. US-guided large core \nneedle biopsy in combination with a US and mammography visible marker \nplacement is useful in type 3 and in type 4 complex-cystic lesions. In type 1 \nand type 2 complex-cystic lesions, a preoperative hook wire placement and \nexcision surgery is the typical procedure.  \nLearning Objectives:\n1. To learn about the US appearance of complicated cysts and complex-cystic \nlesions. \n2. To consolidate knowledge on differential diagnosis for these respective \nlesions. \n3. To understand the diagnostic algorithm for a work-up of these lesions. \nA-032 17:00 \nC. The use of ultrasound in the evaluation of the nipple-areolar complex  \nR. Salvador; Barcelona/ES (rafasalvador@imaginebarcelona.com) \nThe nipple and areola can be well examined by any clinician. Ultrasonography \ncan add new findings mostly related to the main ducts merging at the \nretroareolar region. A thorough description of the anatomical aspects of the \nregion, and its pathological benign and malignant conditions will be described. \nDuct ectasia, infection, ductal papillomas, hyperplasia, and DCIS, as well as \nPaget disease of the nipple and some other skin pathologies can arise in this \narea of the breast. A brief description is presented of the US techniques to \nreview the region, including the use of Doppler US, elastography, 3D \nultrasound, the so-called automated breast ultrasound scan (ABVS) and other \ntechniques that have been used not only to diagnose, but also to treat some \ndiseases. US ductography and pecutaneous sampling or excision of \npapillomas will also be explained.  \nLearning Objectives:\n1. To understand the normal anatomy of the nipple-areolar complex. \n2. To become familiar with conditions commonly affecting the nipple-areolar \ncomplex. \n3. To appreciate the value of US for diagnosis and management of these \nconditions. \nAuthor Disclosure:\n R. Salvador: Advisory Board; Member of the Medical Advsory Board of \nPhilips Healthcare. \n\nA B C D E F G S10  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n16:00 - 17:30 Room G/H  \nGenitourinary  \nRC 307  \nStone disease: new concepts  \nModerator:  \nA. Magnusson; Uppsala/SE \nA-033 16:00 \nA. From the Stone Age to the New Age  \nN.C. Cowan; Oxford/UK (nccowan.uro@gmail.com) \nUrinary tract stones have affected humans since civilisation began. Stones \nwere first reported in the Aphorisms of Hippocrates and are still a major health \nproblem. Their aetiology is multifactorial. Recent advances in diagnosis and \ntreatment have proved significant. The usual presentation is with loin pain, \nvomiting, fever, and nonvisible or visi ble haematuria. They may also be \nasymptomatic. Standard evaluation incl udes a detailed medical history, \nphysical examination, diagnostic imaging, blood analysis and urinalysis. \nPrincipal imaging techniques are ultrasonography and unenhanced CT with \njudicial use of contrast medium enhancement and plain abdominal x-ray. \nSecondary imaging techniques include excretory urography, magnetic \nresonance imaging and antegrade or retrograde pyelography. The advantages \nand disadvantages of these techniques will be discussed. The imaging \ntechnique used depends on diagnostic accuracy, patient acceptability, \navailability, cost and patient safety. Diagnostic imaging is used to determine if \nstones are present and if present to measure the size, number, location and \npossible composition. Imaging may also be used to determine whether there \nhas been an increase in size over a relatively short time period, indicating \nmetabolically active stone disease, or a decrease in size, indicating a response \nto therapy. Imaging may find an underlying anatomical abnormality \npredisposing to stone formation such as pelviureteric junction obstruction or \ntubular ectasia and may also provide essential information regarding the \nfunction of the other kidney. Construction of smart pathways of investigation \nuses ultrasonography and unenhanced CT as principal diagnostic imaging \ntechniques. Various risk factors are used to determine the selection and order \nof diagnostic imaging investigations. The clinical scenarios are explored.  \nLearning Objectives:\n1. To become familiar with the symptoms, signs, risk factors and significance of \nstone disease in the urinary tract. \n2. To understand the strengths and weaknesses of Stone Age to New Age \nimaging techniques for stone disease. \n3. To be able to construct a state-of-the-art diagnostic imaging pathway for \nurinary tract stone disease. \nA-034 16:30 \nB. The contribution of imaging in planning urinary stone therapy  \nU. Patel; London/UK (Uday.Patel@stgeorges.nhs.uk) \nUrinary stone treatment is influenced by stone size, density and composition, \nstone location and the collecting system anatomy. 1. Stone size: renal stones, \n< 1.5 cm in size, are suitable for surveillance. Larger stones, > 2 cm, are better \ntreated surgically by PCNL. 68% of ureteric stones, < 5 mm in diameter, will \nspontaneously pass compared to 47% of > 5 mm. Very small opacities may \nrepresent Randall plaques. The diagnostic appearance of Randall's plaques on \nCT has not been defined, but opacities < 2 mm are likely to be stones. 2. Stone \ndensity and composition: stone density can vary from 100 HU up to > 1400 HU. \nCalcium containing stones can vary from 200-1400 HU, uric acid are 200-\n500 HU, struvite (or matrix) calculi lie in the 100-700 HU range and cystine \nstones are around 300-400 HU. Dense stones are less likely to fragment and a \nthreshold of < 800-1000 HU is the cutoff point for selecting patients for ESWL. \nCystine and calcium oxalate monohydrate stones are relatively resistant to \nESWL. Dual-energy CT is able to differentiate uric acid stones from other \nvarieties, and to a lesser extent can also predict other stone composites (such \nas cystine). 3. Stone location: stones located in the lower third of the ureter are \nmore likely to drain (75% vs. 50%). Location in the kidney is also of \nimportance. 4. Collecting system anatomy: appreciation of the collecting \nsystem anatomy by 3D CT pyelography is the ideal modality for surgical \nplanning.  \nLearning Objectives:\n1. To understand how stone morphology, constituency and intrarenal anatomy \ninfluence treatment of urinary tract stones \n2. To know how to carry out 3D CT reconstruction of the renal collecting \nsystem, and understand key technical factors necessary for recreating \naccurate anatomical or surgical maps. \n3. To understand what information the interventionalist or urologist needs for \nplanning urinary stone therapy. \nA-035 17:00 \nC. Imaging of stone disease in pregnancy  \nG. Masselli, G. Gualdi; Rome/IT (gabrielemasselli@libero.it) \nRenal colic is the most frequent non-obstetric cause for abdominal pain and \nsubsequent hospitalisation during pregnancy. Intervention is necessary in \npatients who do not respond to conservative treatment. Ultrasound (US) is \nwidely used as the first-line diagnostic test in pregnant women with \nnephrolithiasis, despite that it is highly nonspecific and may be unable to \ndifferentiate between ureteral obstruction secondary to calculi and physiologic \nhydronephrosis. Magnetic resonance imaging (MRI) should be considered as a \nsecond-line test, when US fails to establish a diagnosis and there are \ncontinued symptoms despite conservative management. Moreover, MRI is able \nto differentiate physiologic from pathologic dilatation. In fact in the cases of \nobstruction secondary to calculi, there is renal enlargement and perinephric \noedema, not seen with physiological dilatation. In the latter, there is smooth \ntapering of the middle third of the ureter because of the mass effect between \nthe uterus and adjacent retroperitoneal musculature. When the stone is lodged \nin the lower ureter, a standing column of dilated ureter is seen below this \nphysiological constriction. MRI is also helpful in demonstrating complications \nsuch as pyelonephritis. In the unresolved cases, computed tomography \nremains a reliable technique for depicting obstructing urinary tract calculi in \npregnant women, but it involves ionising radiation. Nephrolithiasis during \npregnancy requires a collaboration between urologists, obstetricians, and \nradiologists.  \nLearning Objectives:\n1. To list the US, MR and CT imaging findings of urolithiasis and urinary tract \ninfections. \n2. To discuss the role and the appropriate uses of US, MR and CT for imaging \nthese suspected conditions in pregnancy. \n3. To discuss how imaging can influence the management of nephrolithiasis \nduring pregnancy. \n16:00 - 17:30 Room I/K  \nSpecial Focus Session  \nSF 3  \nPitfalls in FDG PET/CT imaging  \nA-036 16:00 \nChairman's introduction  \nK. Ahlström Riklund; Umea/SE (katrine.riklund.ahlstrom@diagrad.umu.se) \nPitfalls in FDG PET/CT studies will give an overview of what information you \nreally get from an FDG PET/CT study and which pitfalls to avoid. Are all \nuptakes bad or are they also good and how to judge them? The following talks \naim to cover pitfalls in the use of FDG in various fields of medicine.  \nSession Objectives: \n1. To learn about imaging with FDG PET/CT. \n2. To learn about drawbacks and pitfalls. \nAuthor Disclosure:\n K. Ahlström Riklund: Board Member; Swedish Society of Radiology, CMIV, \nLinköping; Sweden, Örebro University, Sweden. Grant Recipient; ALF \nVäserbotten County Council. Speaker; GE user meeting Sweden 1/year (non-\nprofit). \nA-037 16:05 \nOncology  \nT.F. Hany; Zurich/CH (thomas.hany@gmail.com) \nIn malignant tumours, PET/CT imaging using 18-fluoro-deoxyglucose (FDG) is \nwidely used nowadays. FDG-uptake is an unspecific process and results in \nphysiological as well as pathologic al malignant and non-malignant tissue \nuptake. To properly understand and interpret PET/CT imaging, knowledge of \nthe mechanism and pathways of FDG in different tissue types like brain and \nthe gastrointestinal tract is key. Intrinsic as well as extrinsic factors influence \nuptake pattern not related to oncological disease like uptake in brown fat in \npatients exposed to cold ambient temperature and psychological stress or \nincreased muscular uptake in nonfasting patient. Typical treatment-related \nchanges occur during and after treatment and must be recognised correctly so \nas not to overstage patient disease. A systematic analysis and knowledge of all \nthese factors facilitate and improve the reading of oncological clinical cases.  \nLearning Objectives:\n1. To understand pattern of physiological FDG-uptake. \n2. To learn about the pattern of non-patholog ical uptake in several tissue types. \n3. To understand the influence of chemotherapy and other agents on FDG-\nuptake in the body. \n\nA B C D E F G S11  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-038 16:23 \nCardiology  \nJ. Knuuti; Turku/FI (juhani.knuuti@utu.fi) \nThe most common clinical situation for FDG PET/CT is the detection of \nmyocardial viability. Also, FDG PET is increasingly used for detection of \ninflammatory cardiac diseases such as cardiac sarcoidosis. Cardiac tissue \nutilizes various energy substrates and the selection of substrate is mainly \nbased on availability of these and on the metabolic conditions of the patient. \nWhen myocardial viability is studied with FDG PET, the patient must be studied \nin conditions when glucose is the preferred substrate. This can be achieved by \nusing glucose loading or preferably by using  insulin-glucose infusion. Nicotinic \nacid derivatives such as Acipimox can also be used. Diabetic patients are \nchallenging, since tracer remains in the blood for a longer time. Blood glucose \nneeds to be monitored and insulin may be needed. The reporting of viability \nstudies is usually combined with the assessment of perfusion, allowing \nclassifying the myocardial regions into normal, dysfunctional but viable or \nscarred myocardium. With a hybrid PET/CT system, coronary CT angiography \ncan also be performed in the same session. However, in many patients \ninvasive coronary angiography has been already performed. In addition, many \nof these patients have kidney problems, making the use of CT contrast \nchallenging. In inflammatory cardiac diseases the aim is to suppress the \nmyocardial glucose uptake as much as possible and patients should be studied \nin the fasting state or after special low-carbohydrate diet. The challenge is the \nphysiological heterogeneity of glucose utilization in the fasting state. In most \ncases the localized tracer uptake by inflammation can be separated from more \ndiffuse physiological uptake. \nLearning Objectives:\n1. To understand the benefits and limitations of anatomical and functional \nimaging in cardiology. \n2. To learn about the quantitative analysis and limitations of the current \nmethodology. \n3. To become familiar with typical and challenging findings in cardiac FDG \nPET/CT. \nAuthor Disclosure:\n J. Knuuti: Advisory Board; Lantheus Inc. Grant Recipient; Cardirad. \nA-039 16:41 \nNeurology  \nK. Van Laere; Leuven/BE (koen.vanlaere@med.kuleuven.be) \nFDG PET (/CT) is in the CNS mainly used in the routine evaluation of \ndementia, movement disorders, epilepsy and brain tumours. In dementia, the \nmain goal of FDG PET is differential diagnosis (e.g. Alzheimer's disease (AD), \nfrontotemporal dementia, primary progressive aphasia, posterior cortical \natrophy, etc)., as well as for the early diagnosis of AD and prediction of \nconversion in the pre-dementia stage of mild cognitive impairment (MCI). FDG \nPET allows differential diagnosis of parkinsonism (idiopathic versus MSA, PSP \nand CBD) with good accuracy. In refractory epilepsy, FDG PET is used for \ndefinition of the functional deficit zone and lateralisation of the epileptogenic \nfocus and carries high prognostic value in determining surgical outcome. In \nbrain tumours, FDG PET is used for grading and detection of recurrence, best \nused in combination with anatomical information. Methodologically, normal \npatterns need to be discerned, which are age dependent. Although underlying \nCT information is able to provide atrophy assessment, proper partial volume \ncorrection needs more detailed MRI information. When hybrid scanning is \nperformed with CT, movement artefacts need to be prevented to avoid \nattenuation artefacts. Semiquantitative analysis and surface rendering \ntechniques with voxel-based comparison to normal datasets should be applied \nroutinely, to obtain maximal accuracy on the individual patient level.  \nLearning Objectives:\n1. To understand the benefits and limitations of FDG PET/CT in neurological \ndisorders. \n2. To become familiar with the normal and abnormal uptake patterns of FDG in \nthe brain and potential pitfalls. \n3. To learn about the value of semiquantitative analysis of brain FDG PET/CT \nin comparison to normal data. \nA-040 16:59 \nInflammation  \nJ. Sorensen; Uppsala/SE (Jens.Sorensen@medsci.uu.se) \nGlucose transport is increased in inflammatory lesions due to increased \nmetabolic needs of activated inflammatory cells and proliferating connective \ntissue cells. Reports on the use of FDG PET/CT for visualising inflammation \nprovide some evidence for routine clinical  use in selected scenarios such as \nevaluation of patients with prolonged fe ver of unknown origin, infections after \njoint replacement surgery and other osteomyelitic conditions, graft infections \nafter endovascular surgery, vasculitis in autoimmune disorders and patients \nwith granulomatous diseases. This paper covers the documented indications \nand provides an overview of the common pitfalls related to each.  \nLearning Objectives:\n1. To learn about the role of FDG PET/CT in the evaluation of inflammatory \ndiseases. \n2. To understand the shortcomings and pitfalls of FDG PET/CT in inflammatory \ndiseases. \n3. To appreciate the difficulties of differentiating between inflammation, \ninfection and malignancy. \nPanel discussion: Is bright always bad?  \n17:17\n16:00 - 17:30 Room N/O  \nHead and Neck  \nRC 308  \nHead and neck emergency: for the general \nradiologist or the patient?  \nModerator:  \nA. Trojanowska; Lublin/PL \nA-041 16:00 \nA. Pseudolesions mimicking disease  \nC. Karaman; Aydin/TR (cankaraman@hotmail.com) \nRadiologists mostly prefer to use the com parative technique while evaluating \nradiological images, especially when t he anatomy is identical for both sides. \nComparative analysis mostly works if the anatomic details are not complex or \nthe right resembles the left. However, the complex anatomy and relatively high \nincidence of individual variations in head and neck may hinder this way of \ninterpretation. Variable pneumatisati on of paranasal sinuses and temporal \nbone may cause difficulty. Vascular system, especially venous structures may \nbe sources for pseudolesions. For example, asymmetrically enlarged jugular \nvein or venous plexuses at any location may be misinterpreted as mass of any \norigin. Veins may also become problematic on MR imaging due to entry slice \nphenomenon, in-plane flow, and flow turbulence effects and can have variable \nenhancement. Normal anatomical structures such as facial nerve may enhance \nand can be mistaken to be pathologic on MRI. Technical issues can be \nconsidered as a group that may cause pseudolesions. Images of the \nimproperly positioned patient may become problematic while evaluating tiny \nstructures. PET and PET-CT carry their own risks for pitfalls. Normal structures \nmay confound interpretation and result in  false-positive findings. The situation \nmay become much more complicated when there is asymmetry. Similarly, \natrophy and unilateral absence of a structure may be misread as a mass on \nthe contralateral side. Because of the com plex anatomy and relatively high \nincidence of individual variations, head and neck imaging demands much more \nattention and careful analysis. The appropriate imaging technique and detailed \nknowledge of anatomy are essential to recognise pseudolesions.  \nLearning Objectives:\n1. To learn how to choose and tailor imaging techniques according to the \nclinical presentation. \n2. To become familiar with common artefacts. \n3. To be able to recognise typical pseudolesions. \nA-042 16:30 \nB. Where medical history and previous images help to rule out tumour  \nD. Farina; Brescia/IT (nappaje@yahoo.it) \nAs a general rule, detailed knowledge of the patient's clinical history is \nessential before any imaging study is performed, to evaluate the \nappropriateness of the indication, tailor the acquisition protocol and correctly \ninterpret the study. In head and neck imaging, this rule particularly fits in the \nemergency setting. In certain circumstances, the swelling and enhancement of \nsoft tissues produced by infectious lesions may mimic a neoplasm. Even more \nso, in patients already treated with surgery or chemoradiation. In these \npatients, the challenge is double: to identify any abnormality in the new \nanatomy produced by treatment and to discriminate between inflammation, \ncomplication and relapse. These can be very difficult without knowledge, for \nexample, of the reconstructive procedure after surgery. Previous images are \nextremely useful, not only because they help detect abnormalities, but also \nbecause through indirect information on the growth rate of the lesion they are \ncrucial for correct interpretation of findings.  \n\nA B C D E F G S12  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To understand the importance of medical history and previous images. \n2. To become familiar with typical postsurgical and post-radiation imaging \nfindings. \n3. To learn about less common anatomical variants without clinical \nconsequence. \nA-043 17:00 \nC. Findings that can't wait for follow-up  \nM.G. Mack; Munich/DE (m.mack@radiologie-muenchen.de) \nHead and neck emergencies which cannot wait for follow-up are variable. Of \ncourse, all traumatic injuries affecting vascular structures have to be diagnosed \nand treated immediately. Due to the close anatomical relationships, nerves and \nvascular structures can direct inflammatory and tumorous lesion to the skull \nbase and can cause severe clinical complications. It is also important to know \nall the dangerous spaces downwards to the mediastinum, which can also \ncause severe clinical problems. During this lecture, efficient imaging protocols \nand the most relevant traumatic, vascular and infectious emergencies will be \ndiscussed.  \nLearning Objectives:\n1. To learn about vascular head and neck emergencies. \n2. To understand main pathways of skull base invasion. \n3. To be familiar with infections in dangerous spaces. \n16:00 - 17:30 Conf. Room M3  \nComputer Applications  \nRC 305  \nMobile IT in radiology  \nA-044 16:00 \nChairman's introduction  \nE. Neri; Pisa/IT (emanueleneri1@gmail.com) \nTablets in radiology represent a novelty. Since the introduction of the tablets on \nthe market, the radiological field has been probably the first medical discipline \nto discover the many advantages of these devices. In fact, many applications \nfor image management have been made available on the app stores (Apple \nand Android), and allow radiologists and non-radiologists to handle DICOM \nimages on the tablet, as part of the patient's record. However, the emerging \napplications are driving the process from the simple DICOM image viewing to \nthe full integration of the tablet with the PACS, allowing the handling of a \npatient's full record and presumably the possibility to report. In view of this \nrapid technological development, again radiology falls in the middle of a storm \nand is asked to find a solution to problem: are tablets suitable to read and \nreport DICOM images? And if so, which kinds of images (CT, MRI, x-ray, etc).? \nHow can we manage the portability of patients' data (security issues, data loss, \netc).? What will be the impact on teleradiology? These issues will be \naddressed by the panel of experts who will speak in the refresher course.  \nSession Objectives: \n1. To appreciate the current state of tablet technology and its practical use in \nradiology. \n2. To understand the pros and cons of the use of tablets. \n3. To learn about specific critical areas of utilisation (DICOM images reading \nand teleradiology). \nA-045 16:05 \nA. Tablet-computers: a technical overview  \nJ. Fernandez-Bayo; Sabadell/ES (jFernandezB@cspt.es) \nSince their introduction in 2001, tablet PCs have evolved extensively. They \nhave become very popular, filling the gap between laptop computers and smart \nmobile phones. We will review technical aspects like the processors, storage \nspace and memory, size and weight, connectivity and networking, software, \nautonomy, and battery life in different devices. Special focus will be on the \ndisplays and different possible uses in  radiology. For diagnostic purposes, \ndifferent technical aspects must be taken into consideration, like the display \nsize, resolution, pixel size (pixel pitch or pixels per inch), luminance, and \ncontrast. Displays in radiology normally have sizes between 20\" and 24\" and \nresolutions up to 5 Mpx, with luminance that ranges from 250 cd/m\n2 to 600 \ncd/m2. By contrast, tablets have screen sizes between 9\" and 10\" and \nresolutions up to 3 Mpx, with luminance that ranges from 370 cd/m 2 to 480 \nCd/m2. Due to their screen size, tablets score better in pixel pitch, with around \n250 ppi versus 150 ppi in medical displays. The two systems have similar \ncontrast ratios. Other technical aspects of display that we should take into \nconsideration are the number of distinguishable grays that can be represented, \nwhich in tablets correlates with the number of colours that can be displayed \n(Color Gamut) and colour accuracy (Delta-E). Additionally, we should take into \nconsideration that displays should be calibrated for medical diagnostic \npurposes and tools to calibrate tablets have recently become available.  \nLearning Objectives:\n1. To learn about the PC evolution: from desktops, to laptops and tablets. \n2. To appreciate the versatility features of a tablet. \n3. To understand the hardware features with a specific focus on display. \n4. To understand the hardware features with a specific focus on networking. \nA-046 16:28 \nB. Reading DICOM images on the tablet  \nO. Ratib; Geneva/CH \nTouch screen tablets are becoming widel y available, providing convenient \nmobile solutions for physicians and health-care providers. This is particularly \nattractive in medicine to \"nomad\" ph ysicians, who need to be able to access \nrelevant patient data and images anywhere-anytime in their daily practice \nwhere they are rarely at a single location. While they may not always be \nadequate for routine diagnostic tasks, t hey provide a convenient mobile \nsolution for on-call and remote consultations. There are different types of \nsoftware architecture that can be implemented for such tasks. Two different \nmajor designs are: (1) online web-based applications where the device serves \nas a \"thin-client\" to display images rendered and manipulated on a remote \ncomputer and (2) local applications that reside on the mobile device and can \nrun independently after images have been downloaded on the device. The first \nsolution requires the user to be constantly connected to the network, while the \nsecond solution can continue to function after being disconnected from the \nnetwork. Most PACS vendors are starting to provide web access to their \nimaging solutions that can be accessed from mobile devices. Web access can \nhowever be slow and dependent on reliable access to wireless network. We \nchose to develop a stand-alone companion application to our Open Source \nimaging platform OsiriX. With the increasing capacity and computing power of \nmobile devices, users will soon be able to perform most of the processing and \nimage manipulation functions that are today only feasible on desktop or laptop \ncomputers.  \nLearning Objectives:\n1. To learn which DICOM readers are available for tablets. \n2. To appreciate the different approaches to DICOM reading (local vs remote) \nand the PACS/tablets integration. \n3. To understand the pros and cons of DICOM image reading with the tablet in \nregards to image quality and displays. \nA-047 16:51 \nC. Mobile teleradiology: radiological features of the tablet-computer  \nE.R. Ranschaert; 's-Hertogenbosch/NL (ranschaert@telenet.be) \nOver the past few years, several applications and viewers have been \ndeveloped for tablet computers to enable remote viewing and interpretation of \nradiological images. When connected to a wireless network, the images can be \nviewed from any location within or outside the hospital. Both inside and outside \nthe hospital, tablets seem most useful in radiological emergency settings. \nWithin the hospital, tablet computers may have several other purposes such as \nteaching, clinical reviewing and communica tion with referring doctors or even \npatients. Nevertheless, tablet computers still have limitations both in hardware \nand software. The implementation of mobile devices in the hospital \nenvironment also introduces new questions about security and safety of patient \ninformation. These issues and potential solutions will be discussed.  \nLearning Objectives:\n1. To learn about mobile teleradiology within the hospital. \n2. To learn about mobile teleradiology outside the hospital. \n3. To appreciate the potential risks of mobile teleradiology (data security, \nconfidentiality, etc). \nPanel discussion:  \nConfidence in the use of tablets in our clinical practice  \n17:14\n\nA B C D E F G S13  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n16:00 - 17:30 Board Room A  \nVascular  \nRC 315  \nHow to perform venous sampling for \nendocrine disease  \nModerator:  \nW.R. Jaschke; Innsbruck/AT \nA-048 16:00 \nA. Role of venous sampling in localising endocrine disease  \nC. Degenhart; Munich/DE (christoph.degenhart@med.uni-muenchen.de) \nAmong the selective venous sampling procedures for the evaluation of \nendocrine disease, adrenal vein sampling (AVS) and bilateral inferior petrosal \nsinus sampling (BIPSS) are used most frequently. AVS is recommended by \ncurrent guidelines to identify surgical ly curable causes of hyperaldosteronism. \nHowever this procedure is regarded as a challenging procedure and the results \nmay be difficult to interpret. Moreover, there is a lack of generally accepted \nstandards for the performance of AVS. The key issues consist in the selection \nand preparation of the patients for AVS and the procedure for an optimal \nperformance and interpretation of laboratory findings. Cushing's disease (CD) \nis the most common cause of endogenous hypercortisolism and it is caused by \nan adrenocorticotrophin (ACTH) secreting pituitary adenoma. In patients with a \nnegative MRI, a positive BIPSS test is associated with a high rate of \npostoperative biochemical remissi on. When high suspicion of Cushing's \nsyndrome (CS) exists, recommended screening tests include the overnight \ndexamethasone suppression test, the low-dose dexamethasone suppression \ntest, or late night salivary cortisol. Corticotrophin releasing hormone (CRH) test \nhelps to distinguish pituitary CD from ectopic ACTH-dependent CS, BIPPS. In \nspecial cases, less common selective venous sampling procedures are \nindicated for the evaluation of parathyr oid diseases, the localisation of \npancreatic endocrine tumors or the evaluation of ovarian endocrine disease.  \nLearning Objectives:\n1. To learn about the diagnostic accuracy of venous sampling. \n2. To become familiar with the indications for venous sampling. \n3. To learn about the impact of sampling results on patient management. \nA-049 16:30 \nB. Adrenal venous sampling  \nM. Matson; London/UK (matthew.matson@mac.com) \nAdrenal venous sampling is an essential di agnostic tool in the investigation of \nprimary hyperaldosteronism as it can provide information to distinguish \nunilateral from bilateral hyper secretion and thus direct therapy. The place of \nAVS in the diagnostic algorithm will be discussed in relation to cross-sectional \nimaging, and the technicalities of the procedure explained, including common \nreasons for failure and how they can be avoided. Interpretation of the \nbiochemical results will be demonstrated.  \nLearning Objectives:\n1. To learn how to perform adrenal venous sampling. \n2. To learn some tips and tricks for difficult procedures. \n3. To learn about the complications. \nA-050 17:00 \nC. Inferior petrosal sinus sampling  \nD.K. Tsetis; Iraklion/GR (tsetis@med.uoc.gr) \nBilateral Inferior petrosal sinus sampling (BIPSS) is considered by many \ncentres to be the gold standard for confirming the origin of ACTH secretion in \npatients with Cushing's syndrome. The procedure is technically challenging \nand includes the following steps: a) conscious sedation, b) sterile preparation \nof both groins with bilateral insertion of femoral venous sheaths, c) heparin \ninfusion, d) fluoroscopically guided placem ent of catheters into bilateral inferior \npetrosal sinuses, e) contrast-enhanced fluoroscopy to confirm reflux into \nipsilateral cavernous sinus, f) collection of baseline blood samples, g) CRH \ninjection, h) collection of post-CRH injecti on blood samples, i) catheter removal \nand groin pressure until venous haemostasis. Occasionally, it is not possible to \nperform BIPSS via a femoral approach (due to aberrant anatomy, inferior vena \ncava filters, thrombosis, or inability to cross the internal jugular valve) and \nalternative access, such as direct internal jugular access is used. The most \ncommon complication of BIPSS is groin haematoma, occurring in 3-4% of \ncases. Injection of iodinated contrast material may deteriorate renal function, \nso measurement of BUN and creatinine is recommended prior to the \nprocedure. Pre-procedure assessment of the coagulation system, platelets, \nand haematocrit is recommended as heparin is frequently infused following the \ninsertion of sampling catheters to protect against cavernous sinus thrombosis. \nThe placement of the catheter may cause discomfort, headache, ear pain, or \nhearing noises. Very rare complication s include deep venous thrombosis and \npulmonary thromboembolism, pontocerebellar junction stroke, brain stem \ninjury, cranial nerve palsy, venous subarachnoid haemorrhage and obstructive \nhydrocephalus.  \nLearning Objectives:\n1. To learn how to perform sinus venous sampling. \n2. To learn some tips and tricks for difficult procedures. \n3. To learn about the complications. \n16:00 - 17:30 Room P  \nBIA Session  \nBiomedical image analysis: novel tools in \nneurodegenerative disease and breast \ncancer  \nModerator:  \nW.J. Niessen; Rotterdam/NL \n16:00 \nIntroduction  \nW.J. Niessen; Rotterdam/NL (w.niessen@erasmusmc.nl) \nA-051 16:10 \nVPH-PRISM: opening doors in breast cancer care  \nH. Hahn; Bremen/DE (horst.hahn@mevis.fraunhofer.de) \nThe optimisation of clinical breast cancer care comprises the prevention of \nover-diagnosis, reduction of over-treatment, and avoiding unsuccessful \ntreatments. These goals are targeted in the VPH-PRISM project by seven \nEuropean and two US partner institutions. From the prospectively collected \ndata, we will derive optimised imaging protocols that comprehensively take a \nwoman's history and risk factors into account. The tight integration of \nradiological and histopathological images enables joint assessment of \nquantitative tissue parameters from microscopic and macroscopic imaging. \nMore informed therapy decisions can be taken by such enhanced multi-\ndisciplinary data, backed by a powerful case database. The reduction of over-\ntreatment, and highly individualised diagnosis and therapy decisions are \nclosely related. We ultimately aim at deri ving predictive parameters from the \nmulti-modal and multi-disciplinary database to select the treatment option with \nthe best chance of enduring recurrence-free survival. Prospectively collected \ndata, personal risk factors, and corresponding imaging data fed into the \ndatabase from three large cohort studies are expected to provide insights into \nthe individual preconditions and fact ors affecting disease progression. To \noptimise therapy, the decision between therapy options is key. This will be \naddressed by a decision support system using the project database. For \nsurgical excision planning, VPH-PRISM will aim at providing better estimates of \ntumour size, and with visual planning aids supporting radiologists and \nsurgeons. For chemotherapy, quantitative lesion parameters, tracked over time \nduring therapy, may help to detect success or failure of the treatment early on, \nsuch that a chemotherapy regime can for a non-responder be switched to a \ndifferent regime in due time.  \nA-052 16:30 \nQuantitative imaging biomarkers in dementia; the FP7 VPH-Dare@IT \nproject  \nW.J. Niessen; Rotterdam/NL (w.niessen@erasmusmc.nl) \nThe number of individuals suffering from dementia today is roughly 36 million. \nDue to ageing societies, this number is predicted to increase to 115 million by \n2050. Worldwide annual costs are estimated to be €450 billion. In 2012, the \nWHO declared dementia a global health priority, highlighting the urgent need \nfor improvements in this area. VPH-DARE@IT's aim is to enable more \nobjective, earlier, predictive and individualised diagnoses and prognoses of \ndementias to cope with the challenge of an ageing European society. The \nexpected impact of VPH-DARE@IT will influence the scientific, clinical and \nindustrial communities across Europe and internationally to improve health \ncare of dementia patients. In this presentation we will introduce the VPH-\nDARE@IT project. We will then focus on the development, validation and \nimplementation of quantitative imaging biomarkers for the early detection and \ndifferential diagnosis, which will take place as part of the project.  \nAuthor Disclosure:\n W.J. Niessen: Advisory Board; part-time detached to Quantib BV as \nScientific Director. Shareholder; co-founder and shareholder of Quantib BV. \n\nA B C D E F G S14  \nThursday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-053 16:50 \nHorizon 2020: Improving diagnosis and medical interventions and \nsupport to medical imaging  \nJ.-L. Sanne; Brussels/BE (Jean-Luc.Sanne@ec.europa.eu) \nResearch and innovation contribute to increasing Europe’s competitiveness. At \nthe same time, research and innovation help make people’s lives better by \nimproving things like healthcare. In January 2014 the European Union \nlaunches Horizon 2020, the biggest EU research and innovation programme \never, with a budget of € 79 billion (current prices) over seven years (2014-\n2020). EU support for research and innovation helps drive international \nprojects across the European Union and beyond, and promotes the progress of \nknowledge and technology. One of the three key pillars of Horizon 2020 will be \ntackling Societal Challenges (Priority 3) such \"Health, demographic change \nand well-being\". One feature is the development of new and more effective \ndiagnostics. Relevant tools and technology innovations will be supported in \nview to improve disease outcomes through earlier, more accurate diagnosis \nand by allowing for more patient-adapted treatment. Support will be provided \nthrough the Work Programme 2014 - 2015 of Societal Challenge 1 \"Health, \ndemographic change and wellbeing\". Additional opportunities are offered in the \nWork Programme 2014 - 2015 of Priority 2 (Industrial leadership) \"LEIT - \nInformation and Communication Technologies\". \nDiscussion  \n17:10\n18:30 - 18:50 Room A  \nPlenary Session  \nOL  \nPresiding:  \nV.E. Sinitsyn; Moscow/RU \nA-055 18:30 \nEtudes of space radiology  \nO. Atkov; Moscow/RU (cz-oa@css-rzd.ru) \nPractically, all imaging modalities have been used in space research since a \nlong time ago. First of all, radiology is targeted in research activities, because \nby definition all cosmonauts and astro nauts are healthy persons. The biggest \nvolume of examinations had been performed on crew members for studies of \norgans and functions of the human body before and after long-term flights. \nHealth effects of zero gravity were of special interest. For example, multiple \nstudies with involvement of both Russian and international specialists were \ndone on bone mineralisation (bone densitometry), muscle volume (MRI) and \nmetabolism (MR-spectroscopy) both in astronauts and healthy control subjects. \nFirst, ultrasound (US) examinations were conducted in space onboard Russian \norbital stations in 1982. Complex US studies were done by the author himself \nduring his flight as a crew member of \"Salut-7\" orbital station in 1984. The \nauthor had found some complex changes in blood and fluid dynamics under \nweightlessness. Teleradiology was used for data transfer to medical specialists \non the Earth. Today, we are continuing to use radiology for research on \nastronauts. For example, applications of sophisticated brain MRI and fMRI \nmethods are of special interest for studies of subtle brain changes in space \ntravellers. Among our targets are flights to the moon, Mars and large asteroids. \nTo be better prepared for that task, we need better diagnostic tools. New \nversions of mobile US systems, miniature X-Ray and CT machines suitable for \nuse inside spaceships are under development.  \nLearning Objectives:\n1. To learn about the history of imaging experiments on board of space \nstations. \n2. To understand the need for use of radiological examinations in astronauts. \n3. To become familiar with future perspectives of diagnostic imaging in space \nbiomedical research. \n\nA B C D E F G S15  \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n\u000f\u001f\u001a\u0016\u0014#\u0002\u0001\u0010\u0014\u001f\u0015\u0019\u0001\u000b\u0001\n\nA B C D E F G S16  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n08:30 - 10:00 Room A  \nInteractive Teaching Session  \nE³ 420a  \nPitfalls in female pelvic imaging  \nA-056 08:30 \nA. Pitfalls in MRI  \nE. Sala; New York, NY/US (salae@mskcc.org) \nThere are several MRI pitfalls that should be recognised when imaging the \nfemale pelvis. MRI appearances of uterus and ovaries are dependent on the \nphase of menstrual cycle/use of exogenous hormone therapy. Normal \npostsurgical and post-radiation appearances of the pelvis can sometimes \nmimic tumour recurrence. It is important to become familiar with these \nappearances to avoid potential pitfalls. One very common pitfall is \ndifferentiation of transient myometri al contraction from adenomyosis. \nInterrogation of all imaging planes over the duration of the entire MRI \nexamination can be useful to distinguish between the two, although myometrial \ncontractions can last up to 45 min. The choice of the correct imaging plane is \ncrucial for the precise classification of  uterine anomalies (coronal oblique) and \naccurate evaluation of parametrial invasion (axial oblique) in patients with \ncervical cancer. Both dynamic contrast-enhanced MRI and diffusion-weighted \nMRI improve the accuracy of MRI in the evaluation of malignant pelvic \nconditions. However, certain pitfalls rel ated to each technique should be \nrecognised to avoid misinterpretation. It is crucial to be familiar with the \nanatomy of the uterovesical (UV) ligament, as it is often the site of pelvic \nlymphoma (such as bladder or cervix lymphoma). However, some benign \nconditions such as endometriosis can involve the UV fold and invade both \nbladder and uterine wall. Certain MRI features can be helpful in making the \ncorrect diagnosis.  \nLearning Objectives:\n1. To become familiar with normal variations in MRI appearances of female \npelvis resulting from physiological conditions (e.g. different phases of \nmenstrual cycle) and treatments (including exogenous hormone therapy, \nsurgery and radiation) potentially mimicking disease. \n2. To consolidate knowledge on the role of the correct MR imaging plane in \navoiding potential mis-classification of uterine anomalies and parametrial \ninvasion in patients with cervical cancer. \n3. To learn about certain pitfalls related to dynamic contrast-enhanced MRI and \ndiffusion-weighted MRI. \nA-057 09:15 \nB. Pitfalls in ultrasound  \nK. Kinkel; Chêne-Bougeries/CH (karen.kinkel-trugli@wanadoo.fr) \nPitfalls of sonographic findings in the pelvis can be related to technical issues, \ninterpretation errors or to the patient's specific condition or pathology. Common \nproblems consist of insufficient bladder filling, misinterpretation of posterior \nenhancement or shadowing according to the anatomical structure and \npathology of a size that goes beyond the field of view of the probe. Organ-\nspecific problems will be illustrated in interactive questions, particularly for the \nuterus and the ovaries.  \nLearning Objectives:\n1. To become familiar with anatomical variants potentially mimicking disease. \n2. To describe common pitfalls in pelvic ultrasound. \nAuthor Disclosure:\n K. Kinkel: Research/Grant Support; Clinique des Grangettes. \n08:30 - 10:00 Room B  \nGI Tract  \nRC 401  \nMisses and difficulties in abdominal \nimaging\nA-058 08:30 \nChairman's introduction  \nJ. Stoker; Amsterdam/NL (j.stoker@amc.uva.nl) \nIdentification of diseases can be difficult in many areas of abdominal imaging \nand therefore misses are easily made, also by the more experienced \nradiologist. It is difficult in the mesentery and peritoneum, covering a large area \nbut being a very thin structure where abnormalities are easily missed. \nTherefore, knowledge of the peritoneal anatomy and pathophysiology of \nperitoneal diseases is not widespread and di fferential diagnosis can be difficult. \nHence, special attention should be paid to prevent misses. Another difficult \narea is diagnosing occult gastrointestinal  bleeding. Here, the choice of the \nproper imaging method is crucial as well as understanding the pros and cons \nof the method. The technique used should be optimised, as otherwise \nsometimes subtle signs of bleeding are missed. The presence of bowel \ndilatation itself is often correctly diagnosed, but the extent of the obstruction, \nthe cause of the obstruction and especially complications (ischaemia) might be \nmisdiagnosed. CT is the preferred technique for evaluation of bowel dilatation. \nCare should be taken to scrutinise the examination for principal findings in \npatients with bowel obstruction.  \nA-059 08:35 \nA. Mesentery and peritoneum  \nD. Akata; Ankara/TR (dakata@hacettepe.edu.tr) \nImaging findings of neoplastic or inflamma tory diseases within the peritoneal \ncavity and the mesentery sometimes overlap and cause difficulties in \ninterpretation. Even disease processes in the peritoneum, mesentery or \nomentum may not be recognised on radiological examination, causing major \ndifficulties in the management. Perito neal anatomy and physiopathology of \nperitoneal diseases must be well understood for better evaluation. CT is the \nbest modality to assess the whole cavity. MR is equally sensitive with better \ncontrast resolution; however, both modalities have advantages and limitations. \nUltrasound has a complementary role in evaluating the peritoneal fluid content. \nThe presence of lacelike mobile thin septa is highly significant for tuberculosis. \nFor better diagnosing the pathology, systematic approach is needed such as \nassessing the presence or absence of fluid in the peritoneal cavity, its \ncharacter and location, accompanying soft tissue densities and their location. \nSome inflammatory or infectious causes, such as acute pancreatitis and \ntuberculosis, involve typically parietal peritoneum and certain peritoneal \nreflections. Peritoneal carcinomatosis in volves typically both visceral and \nparietal peritoneum as well as subdiaphragmatic space. Contrast enhancement \npatterns of the peritoneal membranes and the mesentery also have a \ncomplementary role in differentiating a variety of diseases.  \nLearning Objectives:\n1. To learn about the imaging character istics of peritoneal and mesenteric \nmasses and their differentials. \n2. To appreciate the potential and limitations of imaging techniques in the \ndetection of such lesions. \n3. To understand the common pitfalls in diagnosis. \nA-060 08:58 \nB. Occult GI bleeding  \nA. Filippone; Chieti/IT (a.filippone@rad.unich.it) \nPatients with persistent, recurrent, or intermittent bleeding from the \ngastrointestinal tract for which no definite cause has been identified by initial \noesophagogastroduodenoscopy, colonoscopy, or conventional radiologic \nevaluation are considered to have an occult gastrointestinal bleeding (OGIB). \nThe management of OGIB is clinically challenging, since the causes of such a \nbleeding frequently arise in the small bowel (SB), until now considered as the \n''dark continent''. Conventional barium contrast studies allow only a limited \nevaluation of SB, whereas angiographic diagnosis is strictly related to active \nbleeding. The introduction of capsule endoscopy (CE) as well as of cross-\nsectional imaging dedicated to the SB visualisation, such as multidetector-row \ncomputed tomography enteroclysis (CTE) and magnetic resonance \nenteroclysis (MRE), represents significant technological advances that have \novercome the limitations of older diagnostic tests. Although CE is \nrecommended as a first-line investigation in OGIB patients, CTE or MRE are \nalternative diagnostic tools when CE is contraindicated due to \nsuspected/known obstruction or stricture. Moreover, in patients in whom a \ntumour is suspected, CTE or MRE may be the preferred initial test. Therefore, \nradiologists have to be familiar with CTE and MRE techniques, in terms of \nbowel distension, scanning parameter selection, contrast administration as well \nas with specific imaging findings. Similarly, they have to be aware of the \npotential pitfalls such as suboptimal bowel distension, artefacts due to \nperistalsis or breathing, intraluminal food debris and previous surgery.  \nLearning Objectives:\n1. To understand the causes of GI bleeding and underlying pathophysiology. \n2. To appreciate the strengths and limitations of the imaging techniques used \nin diagnosis. \n3. To learn about common pitfalls in diagnosis. \nA-061 09:21 \nC. Bowel dilatation  \nE. Danse; Brussels/BE (etienne.danse@uclouvain.be) \nPatients with bowel dilatation frequently require imaging procedures, mainly in \ncase of admission in the emergency room as well as in the early post-operative \nperiod. Plain films, sonography and CT contribute to the management of bowel \n\nA B C D E F G S17  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\ndilatation. Presently, CT takes a major place in this setting with a reduced role \nfor plain films. Sonography is an alternative method when CT is not \nrecommended. The questions of Mondor in 1947 were pointed before the \nadvent of cross-sectional imaging; these are still valid and have to be \nanswered: 1) Is this a true occlusion (how to differentiate it from adynamic \nileus)? 2) Does the obstruction concern the small bowel or the colon (impacting \non the decision to operate or not)? 3) What is the cause of the obstruction? 4) \nAre there signs of bowel ischaemia? The key points to avoid missing imaging \ndiagnoses in bowel dilatation are to make the distinction between true \nmechanical obstruction and adynamic ileus (an early sign of mesenteric infarct) \nand to detect signs of strangulation leading to ischaemia (such imaging \nfindings are present despite normal bl ood tests). In this setting, CT is the \npreferred technique; if it is not available, plain films and sonography can help in \nan optimal medical decision.  \nLearning Objectives:\n1. To become familiar with the normal appearances of the bowel and the \nphysiological causes of bowel dilatation. \n2. To learn about the different imaging techniques to diagnose bowel dilatation \nand their limitations. \n3. To understand common pitfalls in diagnosis. \nPanel discussion:  \nWhat have I learned from misses and can improvements be made to \nreduce misses?  \n09:44\n08:30 - 10:00 Room C  \nControversies in Chest Imaging  \nMC 424  \nComputed tomography screening for lung \ncancer: is it time to implement individual \nlung cancer screening in clinical practice?  \nModerator:  \nD.M. Hansell; London/UK \nTeaser:  \nS. Diederich; Düsseldorf/DE \nA-062 08:30 \nA. Implications of the national lung screening trials (NLST)  \nD.R. Aberle; Los Angeles, CA/US (daberle@mednet.ucla.edu) \nThe National Lung Screening Trial (NLST) found a 20% reduction in lung \ncancer mortality with three annual screens using helical CT relative to chest x-\nray. The US Preventive Services Task Force has issued draft \nrecommendations to provide annual CT screening to high ri sk individuals \ndefined by age and smoking criteria. Questions remain regarding the \nimplementation of CT screening: the determination of risk to identify those who \nshould be screened, the frequency and du ration of screening, definitions of \nscreen positivity based on detected nod ule characteristics, diagnostic \nalgorithms for the follow-up of positive screens, overall societal costs of \nscreening, and methods to adequately diffuse this technology across all \nsocioeconomic groups at risk. Answers to these questions are being \naddressed by several groups through ongoing research and secondary \nanalyses of trial data. Several models exist to identify individuals at highest risk \nof lung cancer (and lung cancer mortality), which may be enhanced if validated \nmolecular markers are included. Ongoing analyses of nodule features and \nlikelihood of lung cancer will better inform screening interpretation guidelines \nand diagnostic algorithms. Estimates from  the NLST suggest that screening as \nperformed in the NLST will be cost effective: the base case estimates $67,000 \nper quality adjusted life year gained (QALY). Subset analyses suggest that \nscreening is much more cost-effective in women than men, in higher versus \nlower risk groups, and in current versus prior smokers. While several variables \ninfluence cost-effectiveness, major drivers of cost are the cost of CT screening \nexams as well as the number of follow-up CT scans per positive screen (1.26 \nin NLST).  \nLearning Objectives:\n1. To learn about the design and findings of the trial. \n2. To understand the harms associated with screening. \n3. To understand the need for better determination of appropriate risk cohorts \nfor screening. \nAuthor Disclosure:\n D.R. Aberle: Advisory Board; Member - LUNGevity Science Advisory Board \n(Unpaid), Consultant - Siemens Medical Advisory Board (Unpaid). Grant \nRecipient; NIH/NCI, U01 CA80098, American College of Radiology Imaging \nNetwork (ACRIN), ACRIN / NIH-NCI Prime 20080299. \nA-063 08:55 \nB. Implications of the European Trials  \nM. Prokop; Nijmegen/NL \nWhile the National Lung Screening Trial (NLST) had shown a significantly \nreduced lung cancer-specific mortality and all-cause mortality, the current \nresults from the various European trials do not show such positive results. The \nDutch-Belgian NELSON trial, the German LUSI trial and the British UKLS have \nnot yet published their results. So far, more cancers were detected in the \nscreening arm of published Danish and Italian trials, but the positive effect on \ncancer mortality could not yet be shown. The Italian MILD trial even showed \nhigher mortality in the yearly screening arm, and no difference between 2-\nyearly screening and the control arm. This presentation discusses the \nimplications of these findings and the consequences on implementation on \nscreening in clinical practice. While lim ited in number of participants, European \ntrials used advanced approaches that are most likely to be used if screening \nwill ever be implemented. This presentation will discuss issues such as growth \nassessment and volumetry as critical factors for nodule assessment, handling \nof sub-solid lesions, computer aided detection and evaluation, and use of non-\nradiologists for reading and standardised follow-up. The goal is to provide an \ninsight into how the European trials have affected our idea on practical \nimplementation of lung cancer screening. \nLearning Objectives:\n1. To learn what positive screening is, what the optimal management \nalgorithms are for the interpretation of scans showing solid or non-solid \nnodules, and how positive subjects should be investigated. \n2. To learn what the optimal follow-up duration and screening interval are. \nAuthor Disclosure: \nM. Prokop: Research/Grant Support; Toshiba Medical Systems. Speaker; \nBracco, Bayer, Toshiba. \nA-064 09:20 \nDiscussion  \nD.M. Hansell\n1, S. Diederich2; 1London/UK, 2Düsseldorf/DE \nThe discussion will address the following issues: \n1. Are there sufficient data to support the implementation of individual lung \ncancer screening in clinical practice? \n2. If yes, how to move from efficacy to effectiveness: \nWhat are the most optimised risk profiles for screening? \nWhat is the minimum level of infrastructure support and organisation required? \nHow should subjects be informed about screening? \nWhat are the optimal follow-up duration and screening interval? \nWhat are the technical and positive screen management requirements? \n3. What about the alternatives of waiting for additional data from ongoing trials \nor the validation of new biomarkers of lung cancer, permitting better selection \nof screened population before implementing  individual lung cancer screening? \nAttendees' opinions will be collected interactively. The speakers will be asked \nto comment and debate. \n08:30 - 10:00 Room D  \nOncologic Imaging  \nRC 416  \nMultiparametric MRI for prostate cancer \nmanagement: the essential guide for \nradiologists\nA-065 \n08:30 \nChairman's introduction  \nH.-P. Schlemmer; Heidelberg/DE (h.schlemmer@dkfz.de) \nProstate cancer is the most frequent cancer in men with high medical and \nsocioeconomic impact. Cancer detection and treatment decision making is \nfrequently based on PSA serum measurement and subsequent TRUS-guided \nbiopsy, although considerable limitations are well known. Multiparametric MR \nimaging (mpMRI) on the other hand provides comprehensive morphologic-\nbiologic information useful as clinically valuable biomarker for: (1) cancer \ndetection and patient stratification  according to individual tumour \naggressiveness, (2) localisation of the most aggressive cancer spot (index \nlesion) in this remarkably multifocal and biologically heterogeneous disease, \n(3) guidance of biopsy and therewith establishing the ultimate diagnosis, (3) \nselection and planning of the individually well-adapted therapy, (4) active \nsurveillance and if necessary guidance of re-biopsies. The method may \nconsiderably contribute to the urgently required separation of clinical significant \nfrom clinical insignificant prostate cancer as overtreatment is still suspected in \n\nA B C D E F G S18  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\na significant number of patients. This course gives an overview of the currently \nexisting knowledge about diagnosis and treatment of prostate cancer and the \nrole of multiparametric MR imaging for individually optimised patient \nmanagement.  \nA-066 08:35 \nA. The clinical arena: when and how to treat prostate cancer  \nF.H. Schröder; Rotterdam/NL (f.schroder@erasmusmc.nl) \nTreatment of prostate cancer depends strongly on the stage of the disease at \nthe time of detection. However, treatment is controversial, even in prostate \ncancers found through early detection. This presentation will be based on a \ncareful recent literature review. Early detection of prostate cancer by use of \nPSA testing leads to a significant reduction of at least 30% of disease-related \nmortality in screened men. This is however at the price of 40-50% of \noverdiagnosis, usually resulting in ov ertreatment. Diagnostic developments \nwhich reduce overdiagnosis and the proper identification of cases which may \nnot require treatment are central issues of current research and will be \naddressed by referring to available eviden ce. Active observation of potentially \nnonaggressive cancers is an option in the management of this disease until, \npreferably, the diagnosis of such cases can be avoided all together. Radical \nprostatectomy and radiotherapy are the options for treating those cancers \nwhich are judged to be aggressive.  \nLearning Objectives:\n1. To learn how the diagnosis of prostate cancer is established through PSA \ntesting and biopsy. \n2. To understand the various treatment options available to the patient. \n3. To become familiar with the role of imaging in clinical decision-making. \nA-067 08:58 \nB. The radiologist's contribution: capabilities of multiparametric MRI in \nclinical routine  \nH. Hricak; New York, NY/US \nTreatment recommendations for prostate cancer continue to evolve and are \naffected by technological advances in surgery, new discoveries in tumour \nbiology, and the development of predic tive and prognostic biomarkers. With the \nincreased complexity of treatment deci sion-making, the role of MRI is also \nevolving. The more individualised and targeted the treatment approach, the \ngreater is the role of imaging in treatment selection, planning and follow-up. \nMRI is especially crucial for planni ng technologically sophisticated treatment \napproaches such as robotic surgery, IGRT, or focal therapy and in assessing \npatients' eligibility for active surveillance. Though needs for uniform \ninterpretation and standardised reporting remain unresolved, the value of MRI \nin pretreatment staging of prostate cancer, particularly for evaluating \nextracapsular extension and seminal vesicle invasion, has been documented. \nNot only the tumour stage, but also its size, volume and grade \n(aggressiveness) are important factors that influence treatment selection. \nTherefore, the introduction of functional MR is essential. When added to T2-\nweighted MRI, diffusion-weighted MRI, dynamic-contrast-enhanced MRI, and \nMR spectroscopy, in addition to improving tumour detection, can provide an \nindication of tumour aggressiveness. MRI performance on all sequences is \ndependent on lesion size/volume and grade, and this should be considered \nwhen applying MRI results to treatment selection and planning. While it has \nbeen shown that multiparametric MRI is generally more accurate and \ninformative than anatomic MRI alone, evidence-based guidelines specifying \nwhich combinations of sequences are ess ential for specific indications in \npatients with prostate cancer are yet to be developed and validated in well-\ndesigned studies with robust outcome measures.  \nLearning Objectives:\n1. To learn how to perform and interpret multiparamteric MRI. \n2. To become familiar with the PiRADS classification system. \n3. To become familiar with the role of imaging for patient stratification and \ntreatment planning. \nA-068 09:21 \nC. The joint action: MR-guided, MR/TRUS-fusion biopsy  \nF. Cornud; Paris/FR (frcornud@imagerie-tourville.com) \nThe accuracy of multiparametric MRI has greatly improved the ability of \nlocalising tumour foci of prostate cancer. This property can be used to perform \na TRUS-MR image registration, a new technological advance, which allows for \nan overlay of an MRI onto a TRUS image to target a prostate biopsy towards a \nsuspicious area. Three types of registrations have been developed: cognitive-\nbased, sensor-based and organ-based registration. Cognitive registration \nconsists of aiming at a suspicious area during biopsy with the knowledge of the \nlesion location identified on multiparametric MRI. Sensor-based registration \nconsists of tracking in real time th e TRUS probe with a magnetic device, \nachieving a global positioni ng system which overlays in real time prostate \nimage on both modalities. Its main limitation is that it does not take into \naccount prostate and patient motion during biopsy Two systems (Artemis and \nUronav) have been developed to partially circumvent this drawback. Organ-\nbased registration (Koelis) does not aim at tracking the TRUS probe, but the \nprostate itself to compute in a 3D acquisition the TRUS prostate shape, \nallowing for a registration with the corresponding 3D MRI shape. This system is \nnot limited by prostate/patient motion and allows for a deformation of the organ \nduring registration. Pros and cons of eac h technique and the rationale for a \ntargeted biopsy only policy are discussed.  \nLearning Objectives:\n1. To understand the clinical challenges and techniques of prostate biopsy. \n2. To become familiar with the MR-guided and MR/TRUS fusion approach. \n3. To learn how MRI improves the diagnosis and characterisation of prostate \ncancer. \nPanel discussion:  \nIs multiparametric MRI essential for the management of prostate cancer \npatients?  \n09:44\n08:30 - 10:00 Board Room B  \nEmergency Radiology  \nRC 417  \nVascular: emergent, not urgent!  \nA-069 08:30 \nChairman's introduction: highlighting the benefits of minimally invasive \nprocedures in vascular emergencies  \nG. Schueller; Bülach/CH (gerd.schueller@spitalbuelach.ch) \nIn major trauma, it is essential to immediately recognise life-threatening \nconditions and to initiate early treatment. The majority of these patients \nsuccumb at the site of the injury to severe injuries of the central nervous \nsystem, heart and great vessels. However, there is another peak of early \ndeaths within the first four hours after the injury. In the majority, these patients \nare at risk due to haemorrhage which is basically controllable by early \nminimally invasive treatment. Consequently, this means that the vast majority \nof internal injuries can be survived as long as bleeding control is achieved \nwithin the first four hours after an injury. Minimally invasive interventional \ntechniques are already in use at a very early stage of the clinical decision-\nmaking process. Particularly, we have witnessed a major paradigm shift in the \ntreatment of blunt aortic injuries. Endovascular repair has replaced open repair \nin many trauma centres. In appropriately selected patients, this adoption of \nendovascular stent grafts has resulted in a reduction in perioperative mortality, \nstroke and paraplegia, as compared to open repair. This entire session will \nprovide knowledge about indications, requirements, standard procedures, and \noutcome of vascular emergencies, pardon me, urgencies.  \nA-070 08:40 \nA. Aortic emergencies  \nM. Cejna; Feldkirch/AT (manfred.cejna@lkhf.at) \nAortic emergencies can be classified into several categories. \"Acute aortic \nsyndrome\": Acute aortic syndrome is an entity of changes of the aortic wall. \nThese include aortic dissection, intramural thrombus, and penetrating \natherosclerotic aortic ulcer. Besides co ronary malperfusion and aortic valve \ninsufficiency (type A dissection), emergency presentation is often due to \nvisceral/limb ischaemia. Sequelae of aortic syndromes are pseudoaneurysm \nformation and potentially aortic rupture. Endovascular treatment has been \nestablished as the treatment option in at least type B dissections and \npenetrating aortic ulcers. Aortic aneurysm rupture: With increasing diameter, \naneurysms in the thoracic, thoraco-abdominal and abdominal aorta are prone \nto rupture. Signs of impending aortic rupture are pain and imaging signs are \nsometimes subtle just like blurred contours of the aorta and (blister like) \nvascular wall deformation. Endovascular treatment is an alternative to vascular \nsurgery. Aortic trauma: In severe thoracic trauma (mostly deceleration trauma), \npseudoaneurysm formation and aortic rupture occur at the level of the aortic \nisthmus. Endovascular treatment is considered the treatment of choice. \nInflammation, mycotic aneurysms and aorto-enteric fistulae: With acute and \nchronic inflammation, aneurysm and pseudoaneurysm formation and fistulae to \nenteric structures can occur. Endovascular treatment is more often considered \nas bridging to vascular surgery instead of being a definitive cure. Iatrogenic \naortic injuries: Besides accidental aortic injury during operations or \ninterventional procedures, transaortic valve replacement and placement of \naortic balloon pumps can result in iatrogenic trauma. Endovascular treatment \nmay be a minimally invasive approach. The focus will be on systematic \npresentation of aortic emergencies and the role of endovascular treatment.  \n\nA B C D E F G S19  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To become familiar with the most important imaging findings and their \nimpact on patient management. \n2. To understand common classification systems and their impact on patient \nmanagement. \n3. To learn about typical interventional radiological procedures. \nAuthor Disclosure:\n M. Cejna: Speaker; ABBOTT, COOK, BIOTRONIK. \nA-071 09:00 \nB. Visceral emergencies  \nG. Goh; London/UK (gerard.goh@stgeorges.nhs.uk) \nThere are a number of vascular visceral emergencies that may be traumatic or \nnontraumatic in origin. The degree of urgency or potential for urgency varies \nwith each condition and the subsequent management and intervention \ntechniques will vary accordingly. An understanding of the natural history, \npathophysiology, diagnostic tests and interventional techniques for these \nconditions will aid the diagnostic and interventional radiologist in identifying the \npathology and knowing when to refer or initiate definitive treatment.  \nLearning Objectives:\n1. To become familiar with the most important imaging findings and their \nimpact on patient management. \n2. To understand common classification systems and their impact on patient \nmanagement. \n3. To learn about typical interventional radiological procedures. \nAuthor Disclosure:\n G. Goh: Consultant; Boston Scientific, Covidien. Research/Grant Support; \nCovidien. Speaker; Cook Medical, St Jude Medical. \nA-072 09:25 \nC. Peripheral emergencies  \nR. Omidi; Bülach/CH (reza.omidi@spitalbuelach.ch) \nI talk about embryonal development and anatomical differentiation of \ncardiovascular system, with special attention to the peripheral vascular system. \nThe goal of this part of presentation would be to understand the anatomical \nstructure and architecture of arteries and capillaries. We will discuss the \nCasual Classification of different kinds of peripheral arterial emegencies; e.g. \ncongenital, posttrauma, arteriosclerotic and iatrogenic. The audience will learn \nabout different therapy approaches, interventional and non-interventional, with \naccent on PAD (classification, pathophysiology, Risk factors, statistical facts \nand therapy). At the end, we will review different studies about combination \ntherapy (conventional and interventional) with different possibilities and \noutcomes.  \nLearning Objectives:\n1. To become familiar with the most important imaging findings and their \nimpact on patient management. \n2. To understand common classification systems and their impact on patient \nmanagement. \n3. To learn about typical interventional radiological procedures. \nPanel discussion:  \nCooperation with clinicians: what still needs to be done?  \n09:45\n08:30 - 10:00 Room E1  \nNew Horizons Session  \nNH 4  \nImaging the hallmarks of cancer  \nA-073 08:30 \nChairman's introduction: importance of cancer hallmarks for radiologists  \nA.R. Padhani; Northwood/UK (anwar.padhani@stricklandscanner.org.uk) \nModern cancer research and increasing therapy are mechanism based with \nthe development of disease-modifying therapies that target the hallmarks of \ncancer. Modern imaging tools enable the visualisation and quantitative \nassessment of the expression of molecular targets, of their interaction with \npotential ligands, as well as of the functional consequences of interactions at a \nmolecular, cellular, metabolic, physiological, and morphological levels in a \ntemporo-spatially resolved manner. The ability to gather such information from \nthe intact organism renders imaging highly attractive for biomedical research \nand drug development.  \nSession Objectives: \n1. To understand that human cancers acquire functional capabilities, which \nallow cancer cells to survive, proliferate, and disseminate acquired during a \nmultistep development process. \n2. To become familiar with established hallmarks (sustained proliferative \nsignalling, evading growth suppressors, resisting cell death, enabling \nreplicative immortality, inducing angiogenesis, and activating invasion and \nmetastasis) and enabling hallmarks (genomic instability and inflammation). \n3. To understand that cancer hallmark development creates vulnerabilities, \nproviding new means to develop treatments for human cancer. \n4. To consolidate knowledge of imaging techniques, which allow for serial \nobservation of the heterogeneous development of hallmark distribution and \nmonitoring of adaptive changes in response to therapy interventions. \nA-074 08:35 \nCell proliferation and death  \nU. Haberkorn; Heidelberg/DE (Uwe_Haberkorn@med.uni-heidelberg.de) \nThe determination of cell proliferation with radiolabelled thymidine is a well-\nestablished method in various life science branches where [3H]thymidine has \nbeen used for more than 40 years and still represents the gold standard for the \nassessment of tumour cell proliferation. Since non-invasive determination of \nthis parameter is required in clinical studies, considerable efforts have been \nmade in radiopharmaceutical research. The synthesis of a large series of \nproliferation markers resulted therefrom mostly focussing on pyrimidine \nnucleosides. The labels used were ga mma as well as positron emitting \nradionuclides. Here, [18 F]FLT (3'-deoxy-3'-fluorothymidine) is examined and \ndiscussed with respect to its preclinical and clinical application. Since \napoptosis is an important mechanism of cell death in tumours responding to \ntreatment, the non-invasive assessment of apoptosis with tracers for the \ndetection of phosphytidyl-serine presentation and/or caspase activation could \nbe used as surrogate marker for therapeutic efficacy. Several approaches have \nbeen followed during the last years; their potential and limitations will be \npresented.  \nLearning Objectives:\n1. To understand the biochemical processes in apoptosis and proliferation. \n2. To learn about the changes in apoptosis and proliferation that can be used \nas targets for the development of tracers. \n3. To learn about the challenges in apoptosis and proliferation imaging. \n4. To consolidate knowledge of preclincial and clinical applications. \nA-075 09:00 \nAngiogenesis  \nF.M.A. Kiessling; Aachen/DE (fkiessling@ukaachen.de) \nAngiogenesis is one of the hallmarks of cancer that is considerably easy to \ncharacterise with many different imaging modalities and methods. It is not only \ncrucial for invasive and metastatic tumour grow th, but is also a prerequisite for \nthe accumulation of anticancer drugs and highly impacts the success of \nradiotherapy. This talk summarises our experiences in microstructural, \nfunctional, and molecular imaging of tumour angiogenesis. The micro-\narchitecture of vessels can longitudinal ly be studied using high-resolution \n(\u0001)CT. DCE MRI and HF-US are introduced as favourable tools to characterise \nperfusion, vessel permeability and vessel maturation during antiangiogenic \ntreatments. Using targeted probes, it is shown that \"fluorescence molecular \ntomography (FMT)\", MRI and US are capable of estimating the expression of \nangiogenic marker molecules on tumour vessels and of matrix-associated \nenzymes in the interstitial space during vascular remodelling. Additionally, \nexamples are also given for EPR-based nano-sized theranostics and it is \nshown how US can aid in better accumulating them at the target site by \ninducing vascular permeation. Many of these novel imaging concepts and tools \ncan relatively easily be translated into clinics. Thus, one can expect them to \nplay a major role in the clinical management of tumour treatments soon.  \nLearning Objectives:\n1. To understand the basic molecular and physiological processes during \nangiogenesis. \n2. To learn about important imaging techniques for characterising vessel \nfunction. \n3. To become familiar with techniques and contrast agent methods for \nmolecular imaging of angiogenesis. \n4. To learn about its potential for basic research and clinical use. \nA-076 09:25 \nDysregulated metabolism  \nK. Brindle; Cambridge/UK (kmb1001@cam.ac.uk) \nTumour cells display high rates of aerobic glycolysis (Warburg effect). While \nthe tumour microenvironment, which is frequently hypoxic, might select for cells \nthat are glycolytic, and thus can generate ATP in the absence of oxygen, it has \nbecome increasingly clear that this and the other metabolic changes observed \nin tumour cells are driven by oncogene activation and tumour suppressor loss. \n\nA B C D E F G S20  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nMoreover, while these metabolic changes are important for generating ATP \nunder the often anaerobic conditions found in the tumour microenvironment, \nthey also have other important functions, such as the generation of metabolic \nintermediates for biosynthetic pathways. This altered metabolism has provided \nnew ways of detecting tumours and their responses to treatment using \nmetabolic imaging. Nuclear spin hyperpolarisation can increase sensitivity in \nthe magnetic resonance experiment by > 10,000x. This has allowed imaging of \ninjected hyperpolarised 13C labelled cell substrates in vivo and, more \nimportantly, their metabolic conversion into other metabolites. Exchange of \nhyperpolarised 13C label between lactate and pyruvate has been shown to \ndecrease post-treatment and hyperpolarised [1.4-13C] fumarate has been \nshown to detect tumour cell necrosis. Tumour pH can be imaged using \nhyperpolarised H13CO3¯ and redox state can be determined by monitoring the \noxidation and reduction of [1-13C] ascorbate and [1-13C] dehydroascorbate, \nrespectively. Tumour glycolysis can be monitored by measuring the conversion \nof hyperpolarised [U-2H, U-13C] glucose to lactate and this flux was shown to \ndecrease post-treatment. This new technique, which has recently transitioned \nto the clinic, has provided new ways of investigating tumour metabolism and \nthe tumour microenvironment and for detecting treatment response.  \nLearning Objectives:\n1. To learn about metabolic imaging using hyperpolarised 13C MR \nspectroscopic imaging and to appreciate its limitations with respect to the short \nhalf-life of the polarisation. \n2. To understand how this technique can be used to study tumour metabolism. \n3. To become familiar with applications of the technique to monitor tumour \nresponses to treatment. \n4. To consolidate knowledge of this technique in relation to other imaging \nmethods for imaging tumour metabolism and for detecting treatment response. \nAuthor Disclosure:\n K. Brindle: Patent Holder; A number of patents held jointly with GE \nHealthcare on the use of hyperpolarised 13C magnetic resonance \nspectroscopic imaging. Research/Grant Support; Research agreement with GE \nHealthcare covering the development of hyperpolarised 13C magnetic \nresonance spectroscopic imaging in oncology. \nPanel discussion: \nCancer hallmarks as therapeutic targets  \n09:50\n08:30 - 10:00 Room E2  \nFoundation Course: Breast Imaging  \nE³ 420b  \nMammography  \nModerator:  \nP. Skaane; Oslo/NO \nA-077 08:30 \nA. Digital mammography: technique and quality assurance  \nM.G. Wallis; Cambridge/UK (matthewwallis492@btinternet.com) \nMammography technique from the point of view of radiographic compression \nand positioning is no different from film  screening and radiologists ignore this at \nour peril. We will discuss the danger areas at the edges and the back of the \nbreast and help you to find lesions only se en on one view. With digital capture \nthe technologist can view images immediately, but the temptation is for them to \nrepeat exposures to obtain radiographic perfection on otherwise clinically \nacceptable images. However, the task of assessing quality cannot be left to \nthem, as viewing conditions on the 'lower resolution' acquisition monitor in a \nbright x-ray room is not enough. There is now evidence from 2 population \nscreening programmes that poor image quality can reduce cancer detection \nfrom between 15% in France to 24% in Ontario. 'Quality' can be lost at 3 keys \npoints in the imaging chain: the x-ray beam and dose, the detector and finally \ndisplay. In Flanders, poor detector performance was compensated for by \nincreasing the x-ray dose by 60% and by meticulous quality control. Post-\nprocessing is less well understood, but reader studies now show different \nalgorithms will affect performance particularly for the detection and \nclassification of micro-calcifi cation. Finally, it does not matter how good all the \nequipment is if we try and read the images with the lights on full.  \nLearning Objectives:\n1. To become familiar with basic digital mammography techniques. \n2. To appreciate radio-anatomical considerations. \n3. To understand what can go wrong if the quality is not adequate. \nA-078 09:00 \nB. Tomosynthesis and contrast-enhanced digital mammography  \nJ. Barkhausen; Lübeck/DE (joerg.barkhausen@uksh.de) \nMammography is the most important breast imaging technique allowing the \nvisualisation of masses and micro-calci fications. However, in conventional \nmammography the three-dimensional breast tissue is reduced to a two-\ndimensional image. Therefore, small lesions may be undetectable due to \nsuperimposed glandular tissue. Digital breast tomosynthesis (DBT) has \nemerged as a new imaging modality to overcome this limitation. Several low-\ndose mammographic projections are performed over a limited angle of up to 50 \ndegree using a standard mammography system. The average glandular dose \nof a tomosynthesis scan is somewhat higher compared to one-view \nmammography, but lower compared to a standard mammography in two \nprojections. Based on the low-dose projections, a stack of cross-sectional \nimages covering the entire breast is reconstructed with an interslice distance of \nabout 1 mm. Several studies have shown that tomosynthesis improves both \ntumour detection and the characterisation of focal masses. Due to the cross-\nsectional nature of DBT, the techniques allow on the one hand the reliable \ndifferentiation of true focal masses from summation artefacts. On the other \nhand, tomosynthesis improves the detailed analysis of the lesions' border to \ndifferentiate benign lesions and carci nomas. Additionally, contrast-enhanced \nspectral tomosynthesis may allow analysing signal-intensity time curves. In \nconclusion, DBT adds important information to standard two-projection \nmammography and can replace spot compression and rolled views as problem \nsolver for difficult cases. However, the impact of tomosynthesis on breast \ncancer screening has to be investigated in larger clinical trials.  \nLearning Objectives:\n1. To understand the implications of switching to 3D (technique, dose, \nreading). \n2. To become familiar with the pros and cons of 2D vs. 3D reading. \n3. To learn about the effects of digital tomosynthesis on productivity. \nA-079 09:30 \nC. Screening mammography  \nE. Azavedo; Stockholm/SE (edward.azavedo@ki.se) \nReading screening mammograms is not the same as reading diagnostic \nmammograms. The vast majority of women attending a screening programme \nare usually asymptomatic and do not have abnormalities associated with a \nmalignancy. The task of a mammogram reader is to scan a mammogram and \nperceive any possible abnormalities that could be associated with a \nmalignancy. In other words, we are talking about perception and not diagnosis \nof a finding. Examples will be shown about this crucial step. In modern \npopulation-based screening programmes, we use computerised reading and \nrecording systems. Since the work flow is rather quick, we have to ensure \nbasic steps such as identity control and see that both RIS and PACS are \nsynchronised so that decisions of screening readings are recorded in both the \nsystems of one and the same patient. In computerised screening programmes, \nwe use standard reports informing a woman that no signs of malignancy have \nbeen detected on her screening mammograms. In case of findings that need \nfurther assessment, there are several ways to deal with this situation. The most \ncommon way is via a phone call, but this can also be done with a letter. A \nscreening report should be short and concise and should only inform whether \nwe see signs of a possible abnormality that can be associated with a \nmalignancy. Extensive reports describing the contents of a breast or findings of \nno clinical relevance should not be part of a screening report.  \nLearning Objectives:\n1. To understand the basics of human vision. \n2. To become familiar with the key components of a computerised \nmammography reading system. \n3. To learn about reporting strategies. \n\nA B C D E F G S21  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n08:30 - 10:00 Room F1  \nJoint Course of ESR and RSNA (Radiological Society  \nof North America): Emergency Radiology  \nMC 422  \nGeneral principles: paediatric and ENT \nemergencies  \nModerators:  \nS.E. Mirvis; Baltimore, MD/US \nA. Palko; Szeged/HU \nA-080 08:30 \nA. General principles  \nU. Linsenmaier, S. Wirth; Munich/DE \n(Ulrich.Linsenmaier@kliniken-pasing-perlach.de) \nEmergency radiology services are very much on the rise in the last decade. \nMedical emergencies and trauma are of enormous importance and a leading \ncause of death in all age groups. The use of radiological imaging in emergency \ndepartments showed an exponential increase since the 1990s. The annual \ngrowth rate in CT is 5-15% per year depending on the institution. Even for \nadvanced level 3° medical centres running an own emergency radiology unit, it \nis a challenge to integrate advanced radiology services in an interdisciplinary \nteam treating patients with acute traumatic and non-traumatic emergencies. \nGeneral principles: radiology and radiological imaging procedures should be \nintegrated in an interdisciplinary team. Imaging should be guided by \ninterdisciplinary clinical algorithms or guidelines (e.g. NEXUS or Canadian C-\nspine Rule). Many clinical diagnoses relay today on a early and thorough initial \nradiological diagnostic workup - mostly based on MDCT. Emergency radiology \n(ER) is still a relatively young subspecialty in European radiology - it deserves \nspecific training. The lecture will cover: the development of emergency \nradiology and its future perspectives; the use of conventional radiography, \nultrasound and MDCT; logistics and management of the patient; clinical \nguidelines and MDCT in the primary patient survey (e.g. using ATLS for \ntrauma) and advanced scanning protocols for MDCT.  \nLearning Objectives:\n1. To learn about general principles of diagnostic imaging in emergency \nradiology in traumatic and non-traumatic emergencies. \n2. To understand the etiology, background and management of common \nradiological emergencies. \n3. To appreciate the role, indications and protocols for US, CR, MDCT in \nmodern emergency radiology. \nA-081 09:00 \nB. Challenges of imaging paediatric abdominal emergencies  \nS.D. John; Houston, TX/US (Susan.D.John@uth.tmc.edu) \nInfants and children with abdominal emergencies present special diagnostic \nchallenges because of similarities in clinical findings between various \npaediatric conditions. Imaging is freq uently a critical part of the diagnostic \nprocess, but the choice of the best imaging modality can be controversial. \nPatient age and safety issues such as radiation exposure must be taken into \nconsideration when planning imaging. Because certain pathologies are more \nlikely to occur in specific age groups, patient age is a primary determinant of \nthe imaging approach. This presentation will illustrate the differences in \npathology between several paediatric age groups and discuss effective \nimaging algorithms for congenital and developmental, inflammatory, and \nobstructive conditions. The optimal us e of radiographs, ultrasound, CT, and \nMRI will be discussed. Pitfalls that should be avoided in ultrasound and CT will \nbe emphasised.  \nLearning Objectives:\n1. To learn how to plan safe and effective imaging strategies for evaluating \nabdominal pain in infants and children. \n2. To understand the common and unusual causes of abdominal pain in \ndifferent paediatric age groups. \n3. To become familiar with potentially confusing variations in the appearance of \nthese conditions with imaging. \nA-082 09:30 \nC. Imaging in ENT emergencies  \nD. Nunez; New Haven, CT/US (Diego.Nunez@ynhh.org) \nNon-traumatic emergent conditions involving the ear, nose and throat comprise \na variety of disease entities, some of which may become life threatening if not \nreadily recognised and treated. They typically present as bleeding, or as \ndifficulty in breathing or swallowing. Occasionally, imaging studies may aid in \nthe appropriate localisation of airway obstructing foreign bodies or in the \ndiagnosis and treatment of epistaxis by guided interventional procedures. It is \nhowever in the assessment of head and neck infections and their \ncomplications that cross-sectional imaging plays a fundamental role. Facial \nand cervical infections are common clinical problems and although a \npresumptive diagnosis can be made clinically, imaging studies are often \nrequested to confirm the diagnosis, to localise the infectious process and \nimportantly to exclude the possibility of abscess formation or other \ncomplications. The contribution of imaging becomes more relevant in patients \nwith clinical suspicion of deep neck infection where access to appropriate \nclinical evaluation may be limited. This presentation will analyse the imaging \nfindings of head and neck infections usi ng a systematic a spatial approach, as \nwell as the indications for emergent CT and MR when necessary. A variety of \ncomplications will be discussed including intracranial extension of disease, \nairway compromise, vascular lesions and osseous involvement.  \nLearning Objectives:\n1. To understand imaging findings in patients presenting with acute head and \nneck conditions using a systematic spatial approach. \n2. To get an understanding of the role and indications of CT and MR in acute \nnon-traumatic ENT case management. \n3. To learn how to identify the extent of disease and recognise specific \ncomplications of cervicofacial infections. \n08:30 - 10:00 Room F2  \nRadiographers  \nRC 414  \nChild protection issues: raising awareness \namong medical imaging professionals  \nA-083 08:30 \nChairman's introduction  \nJ. McNulty; Dublin/IE (jonathan.mcnulty@ucd.ie) \nIn diagnostic imaging, we tend to focus on radiation protection, justification and \noptimisation, as the primary opportunity for radiographers and radiologists to \nensure the safety of patients, both adults and children; however, this ignores \nsome other important issues. This session aims to raise awareness amongst \nmedical imaging professionals of some key considerations in relation to a \nnumber of child protection issues. When imaging a child in case of suspected \nnon-accidental injury, every detail of that examination from conversations with \nthe child and their parents or guardians, technical aspects of the examination, \nobservations during the examination and the language used following the \nexamination need to be carefully considered. Another area of medical imaging \nrequiring attention is how we communicate any radiation risks associated with \nexaminations or procedures with children and their parents. There is evidence \nthat while consent processes for invasive procedures are usually in place, \nthese often lack focus on the risks associated with a high exposure to ionising \nradiation. These two medico-legal areas, suspected non-accidental injury and \nrisk communication, are commonly encountered by radiographers and \nradiologists and as such it is important to make sure that we operate at the \nhighest possible professional standard s and in keeping with both regulations \nand best practice including the production of witness \nstatements/contemporaneous notes. On rare occasions, we may find ourselves \ninvolved in legal proceedings as a witness or expert witness and it is thus \nimportant that we are all aware of the key considerations in this regard.  \nSession Objectives:\n1. To appreciate the need for radiographers to focus on more than just the \nimaging procedure in paediatric examinations. \n2. To understand the extremely vulnerable nature of paediatric patients and the \nneed for all health professionals to pay particular attention to this. \nA-084 08:35 \nA. Professional responsibilities: an international perspective  \nM. Davis; Dublin/IE (michaela.davis@ucd.ie) \nRadiographers play a vital role in imaging children with suspected non-\naccidental Injuries. This session will also explore the wider role that \nradiographers have in child protection. Current legislation and its implications \nwill be explored from a variety of countries including those outside Europe. In \naddition, case studies will be presented focussing upon child protection issues \nthat have arisen in the x-ray department during imaging procedures. Several of \nthe barriers to radiographers becoming involved in child protection will be \nexplored. Radiographers and their contribution to child protection will be \ndiscussed and practical examples given.  \n\nA B C D E F G S22  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To become familiar with current legislation and guidelines which have \nparticular relevance to radiographers from an international perspective. \n2. To appreciate best practice in child protection and the need for all \nradiographers to be aware of this. \n3. To learn about child protection case reports involving imaging, radiologists \nand radiographers. \nA-085 08:58 \nB. Risk communication in paediatric examinations  \nJ.L. Portelli; Msida/MT (jonathan.portelli@um.edu.mt) \nMedical imaging plays a vital role in the diagnosis and treatment of numerous \nmedical conditions for millions of patients worldwide. However since most \nmedical imaging examinations utilise ionising radiation, the associated risks of \nradiation exposure also need to be acknowl edged, especially since high doses \nof radiation are known to cause ad verse biological effects. Medical imaging \nprofessionals should have a good understanding of the benefits and risks \nassociated with the imaging examinations they perform, so as to ensure a high \nbenefit-risk ratio for all patients undergoing diagnostic imaging procedures, and \nto be able to appropriately communicate such information to patients, their \nfamilies and other healthcare professionals. This may be particularly more \nimportant when imaging paediatric patients, who are relatively more \nsusceptible to the effects of radiation and receive a higher effective dose per \nunit of radiation when compared with adults undergoing the same medical \nimaging examination. Indeed, following worldwide media attention about \nradiation incidents and their adverse effects, some parents/legal guardians \nmay be concerned and reluctant to pursue important medical imaging \nexaminations requested for their child, as they may have a misconception of \nthe risks involved. In this regard, this lecture will seek to enhance awareness \nabout the radiation doses associated with common paediatric imaging \nexaminations; highlight the importance of medical imaging professionals \nhaving an appropriate understanding of benefits and risks associated with \nthese examinations; and encourage such professionals to improve patient care \nby making use of this knowledge to have better discussions with referring \nclinicians, patients and their families.  \nLearning Objectives:\n1. To appreciate the frequency and radiation dose associated with certain \npaediatric imaging examinations. \n2. To become familiar with the current status quo in the communication of \nradiation dose-related risks. \n3. To understand best practice and potential considerations in providing \naccurate information to referring clinicians, patients and their families. \nA-086 09:21 \nC. What to do if you find yourself being called to give evidence  \nM.D. Viner; London/UK \nRadiology is a powerful tool in the investigation of cases of suspected non-\naccidental injury and suspicious deat h in children. The evidence obtained can \nbe pivotal in bringing successful prosec utions against suspects and protecting \nthe child and others from further harm. It is essential that evidence is obtained, \nrecorded and presented in accordance with applicable rules of evidence in \norder to be admissible in court. It is thus important that those undertaking such \nexaminations are appropriately trained, conversant with standards of evidence \nand maintain continuity of evidence throughout the investigation. This \npresentation will review rules of evidence for cases of suspected child abuse \nand their application to imaging examinations. It will examine the role of the \nradiographer and the importance of training and familiarity with legislation and \nguidelines that underpin forensic practice, highlighting the pitfalls that lawyers \nmay exploit if procedures have not been followed. Drawing on examples, it will \ndiscuss best practice from the radiographer's perspective, detailing the \nimportance of continuity of evidence and maintenance of contemporaneous \nnotes and witness statements. It will address key considerations for \nradiographers and others who provide evidence or act as an expert witness. \nImaging professionals play a pivotal rol e in the investigation of suspected child \nabuse. It is essential that this evidence is obtained, recorded and presented \nwith regard to the applicable standards of evidence. For those called to give \nevidence, the importance of appropriate imaging protocols and procedures, \ndetailed documentation and thorough preparation cannot be understated.  \nLearning Objectives:\n1. To understand the importance of contemporaneous notes and witness \nstatements if involved in any forensic or suspected non-accidental injury \nexamination. \n2. To become familiar with the importance of continuity of evidence in forensic \nexaminations. \n3. To appreciate the key considerations if you are asked to provide evidence or \nact as an expert witness in court. \nPanel discussion:  \nIs there a need for further education and training for radiologists and \nradiographers?  \n09:44\n08:30 - 10:00 Room G/H  \nNeuro  \nRC 411  \nThe paediatric brain: not just a small brain  \nModerator:  \nN. Girard; Marseille/FR \nA-087 08:30 \nA. Neurocutaneous syndromes: more than neurofibromatosis  \nB. Ertl-Wagner; Munich/DE (Birgit.Ertl-Wagner@med.uni-muenchen.de) \nNeurofibromatosis type 1 is the most common, but certainly not the only \nneurocutaneous syndrome. In children, white matter signal alterations are a \ncommon neuroimaging finding. The incidence of optic gliomas and other \ngliomas has increased. Neurofibromas can occur in almost any body region. \nPlexiform neurofibromas show a diffuse and often locally destructive growth. \nNeurofibrosarcomas are malignant nerve sheath tumours. Neurofibromatosis \ntype 2 is characterised by \"acoustic neuromas\" (mostly vestibular \nschwannomas), which can be uni- or bilateral. Schwannomas can also affect \nother cranial nerves and spinal nerves. The incidence of meningiomas and to a \nlesser extent of gliomas is also increased. The hallmark feature of tuberous \nsclerosis is the combination of cortical or subcortical tubers and subependymal \nnodules. Tubers are hyperintense on T2w and FLAIR sequences. \nSubependymal nodules are NOT isointense to grey matter (vs. subependymal \nheterotopias). Giant cell astrocytomas are located at the foramina of Monroi, \nincrease in size over time and show a contrast enhancement. Sturge-Weber \ndisease (encephalotrigeminal angiomatosis) is characterised by a \nleptomeningeal angioma and facial naevus flammeus. There is increased \nleptomeningeal enhancement and hypertrophy of the ipsilateral choroid plexus. \nAtrophy of the affected region and tramtrack  calcifications typically ensue. Von \nHippel-Lindau disease is not a neurocutaneous syndrome per se, but \nclassically considered a phakomatosi s. Typical features include \nhaemangioblastomas of the brain, spinal cord or retina, and papillary \ncystadenomas of the endolymphatic sac. Most neurocutaneous syndromes \nhave manifestations outside the central and peripheral nervous systems as \nwell. Moreover, there are multiple rare neurocutaneous syndromes.  \nLearning Objectives:\n1. To become familiar with the typical clinical presentations of neurocutaneous \nsyndromes. \n2. To consolidate knowledge of the typical imaging patterns of the major \nneurocutaneous syndromes. \n3. To become familiar with some less common features of neurocutaneous \nsyndromes. \nA-088 09:00 \nB. Patterns of white matter disease in children  \nA. Rossi; Genoa/IT (andrearossi@ospedale-gaslini.ge.it) \nPediatric white matter disorders can be distinguished into well-defined \nleukoencephalopathies and undefined leukoencephalopathies. The first \ncategory may be subdivided into: (a) hypomyelinating disorders; (b) \ndysmyelinating disorders; (c) leukodystrophies; (d) disorders related to cystic \ndegeneration of myelin; and (e) disorders secondary to axonal damage. The \nsecond category, representing up to 50% of leukoencephalopathies in \nchildhood, requires a multidisciplinary approach in order to define novel \nhomogeneous subgroups of patients, possibly representing '\"new genetic \ndisorders''. An integrated description of the clinical, neuroimaging, and \npathophysiological features is crucial for categorising myelin disorders and \nbetter understanding their genetic basis. A review of the MR imaging findings \nin the main genetic disorders affecting white matter in the pediatric age, \nincluding some novel entities, will be provided with a highlight on the concept \nof pattern recognition.  \nLearning Objectives:\n1. To become familiar with the most common white matter diseases in children. \n2. To learn how to differentiate between white matter diseases in children. \n3. To consolidate knowledge of appropriate imaging protocols for MRI of \nchildren with white matter disease. \n\nA B C D E F G S23  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-089 09:30 \nC. Paediatric brain tumours  \nM. Bekiesinska-Figatowska; Warsaw/PL (m.figatowska@gmail.com) \nBrain tumours are the second most common neoplasms in children after \nleukaemia. As \"paediatric brain is no t just a small brain\", paediatric brain \ntumours are not the same as tumours in adults. MRI is a method of choice in \ntheir diagnosis in accordance with the principle ALARA in the paediatric \npopulation. By the age of approximately 3 years, supratentorial tumours \ndominate; later (4-10 years of age), the majority of children show infratentorial \nneoplasms which are pilocytic astrocytomas, most often found in the \nhemispheres, and medulloblastomas or ependymomas - in the fourth ventricle. \nAfter the age of 10, both groups are diagnosed with equal frequency. Cerebral \nhemispheric tumours include astrocytoma which is the most frequent, teratoma \nin neonates, and in older children atypical teratoid/rhabdoid tumour, \nependymoma, PNET, ganglioglioma and DNET. In the midline, we deal with \nchiasmatic or hypothalamic glioma, craniopharyngioma and germ cell tumours \nof the pineal region. Extraparenchymal tumours are uncommon in the \npaediatric population. Apart from the location, imaging pattern in various \nsequences, and contrast enhancement of the tumour, advanced MRI \ntechniques are helpful in establishing t he diagnosis. DWI helps to differentiate \nbetween tumours of high and low cellularity showing low ADC values in case of \nmedulloblastoma and high in astrocytoma. MRS, PWI and DTI also add \nimportant information to the diagnosis. MRI of the spinal canal is obligatory in \ncase of these primary brain neoplasms that have a high propensity to \nmetastasise to other parts of the central nervous system such as \nmedulloblastomas, ependymomas, high-grade gliomas, cerebral \nneuroblastomas, and pineal region neoplasms.  \nLearning Objectives:\n1. To learn about the difference between paediatric and adult brain tumours. \n2. To understand the imaging strategy for the paediatric population. \n3. To become familiar with the most common paediatric brain tumours. \n08:30 - 10:00 Room I/K  \nMultidisciplinary Session: Managing Patients with Cancer  \nMS 4\nPancreatic neuro-endocrine tumours  \nA-090 08:30 \nChairman's introduction  \nR. Pozzi-Mucelli; Verona/IT (roberto.pozzimucelli@univr.it) \nPancreatic endocrine tumours (p-NETs) include both pancreatic \nneuroendocrine tumours associated with a functional syndrome (functional p-\nNETs) and those associated with no distinct clinical syndrome (non-functional \np-NETs). Non-functional p-NETs may show immunohistochemical positivity for \nhormones which may be produced, but not secreted, which are clinically inert \nand whose serum concentrations are insufficient to induce symptoms. Among \nfunctional p-NET, the most common are gastrinomas and insulinomas, \nwhereas those secreting vasoactive intestinal peptide, glucagon, somatostatin \nand other hormones are considered together as a group called rare functional \np-NETs. Non-functional p-NETs are classified, according to the WHO 2010 \nclassification, in well-differentiated neuroendocrine tumours and poorly \ndifferentiated neuroendocrine carcinomas (NECs) of small or large cell type. \nWell-differentiated neuroendocrine tumours are then divided according to a \ngrading scheme based on mitotic count or Ki67 index in NETs-G1 (with a \nmitotic count < 2 per 10 high-power fields (HPF) and/or \u0001 2% Ki67 index), and \nNETs-G2 (with a mitotic count 2-20 per 10 HPF and/or 3-20% Ki67 index). All \npoorly differentiated neuroendocrine carcinomas are graded G3 (with a mitotic \ncount > 20 per 10 HPF and/or > 20% Ki67 index). Most pancreatic non-\nfunctional p-NETs are well-differentiated tumours, whereas poorly \ndifferentiated neuroendocrine carcinomas are uncommon.  \nSession Objectives: \n1. To understand the biology, clinical presentation and recent classification of \npancreatic NET. \n2. To recognise the role of multimodality imaging in detecting, staging and \ncharacterising biological patterns of lesions. \n3. To become familiar with the different treatment options. \nA-091 08:35 \nRadiologist's point of view  \nR. Pozzi-Mucelli; Verona/IT (roberto.pozzimucelli@univr.it) \nPancreatic endocrine tumours (p-NET) are divided into functional p-NETs and \nnon-functional p-NETs. Diagnostic imaging of these tumours includes \ndetection, characterisation and staging. There are significant differences when \ndealing with functional p-NETs and non-functional p-NETs. In fact, in the first \ncase the main aim of diagnostic imaging modalities is the detection of the \ntumour, while for non-functional p-NETs the main aim is the characterisation \nand the differential diagnosis with other tumours of the pancreas, mainly with \npancreatic adenocarcinoma. Staging is also important for both tumours, but \nmainly for non-functional p-NETs. A large number of imaging modalities are \navailable, both \"morphological\" and \"functional\". We can arbitrarily divide the \nimaging modalities for the diagnosis of p-NETs into three levels: the first level \nincludes US (with contrast-enhanced US), MDCT, MRI and nuclear medicine \ntechniques; the second, endoscopic US, angiography and venous sampling; \nthe third, intra-operative US. Functional p-NETs are represented mainly by \ninsulinomas and gastrinomas which are small in size in most cases. Their \ndetection is still difficult, but significant improvements have been made with \nUS, MDCT and MRI, so that these tumours are detected in most cases if \nappropriate imaging techniques are performed. However, still, no single \nmodality is 100% effective. Non-functional p-NETs can be differentiated from \npancreatic adenocarcinoma, since they are hypervascular and usually large in \nsize. Since they are potentially malignant, they require accurate staging by \nimaging modalities, both morphological (MDCT, MRI) and functional (PET/CT) \nto plan surgery and chemotherapy.  \nLearning Objectives:\n1. To learn how to recognise the specific imaging features of pancreatic NET \nand how to differentiate NET from other pancreatic tumours. \n2. To understand the strengths and weaknesses of the different imaging \nmodalities. \n3. To learn about the optimal imaging protocol for the diagnosis, staging and \nfollow-up of NETs. \nA-092 08:55 \nSurgeon's point of view  \nC. Bassi; Verona/IT (claudio.bassi@univr.it) \nThere is worldwide consensus about surgical treatment of resectable p-NETs \nin the following clinical situations: proven malignancy, whenever it is possible \nto remove the primary tumour and at least 90% of liver metastases (debulking); \np-Nets associated with a clinical syndrome caused by hormonal hypersecretion \n(insulinomas and gastrinomas mainly); non-functional p-NETs with a size larger \nthan 2 cm. Vice versa, there are different expert opinions about the surgical \ntreatment of functional and non-functional p-NETs in MEN1 syndromes and in \nsporadic non-functional p-NETs less than 2 cm in size. In MEN1 all \ninsulinomas should be resected, while for gastrinomas the extent of resection \nis patient tailored, deserving standard Whipple for selected cases. In the most \ncommon sporadic small incidentalomas, where long-term prognosis is \nfavourable, surgical treatment has to be weighted with co-morbidities and \nmorbidities of the patient and the procedure planned. These tumours have a \nrisk of node metastases at the time of diagnosis in less than 10 % of patients. \nWhenever possible, mini-invasive approach with pancreas-sparing operations \nshould be recommended. In elderly patients, a first period of follow-up should \nbe preferable and surgery should be offered only if the size of the tumour \ndemonstrates increasing trends.  \nLearning Objectives:\n1. To understand the rationale of surgical indication. \n2. To consolidate knowledge on the resectability criteria and extension of the \nradical resection. \n3. To learn about the role of surgery within multimodality treatment. \nA-093 09:15 \nOncologist's point of view  \nG. Tortora; Verona/IT (giampaolo.tortora@univr.it) \nG1-G2 Pancreatic NETs show moderate responsiveness to chemotherapy. \nWhile single agents have limited activity in advanced pNETs, doublet \ncontaining streptozotocin with adriamycin or 5-fluorouracil are considered \nstandard regimens, leading to RR from 6 to 36%, median PFS from 3.9 to 16 \nmonths and OS of 20-24 months. Intensification with three drug regimens did \nnot increase the efficacy. Recently, a combination of temozolomide and \ncapecitabine showed 70% of partial remission, median PFS of 18 months and \nOS of 92% at 2 years. PI3K-Akt-mTOR is a key pathway in NETs. In advanced \npNETs, the phase III registrative RADIANT-3 study randomised patients to the \nanti-mTOR everolimus versus placebo; pretreatment with chemotherapy was a \nstratification criteria and treatment with SSA was allowed. PFS, the primary \nend point was 11.4 months with everolimus versus 5.4 months in the placebo \narm, with a reduction in the risk of progression of nearly 65%. NETs are highly \nvascularised tumours and high VEGF expression is a negative prognostic \nfactor in pancreatic NET, related to higher microvessel density, higher \nincidence of metastases and shorter PFS. A phase III registrative study \nrandomised advanced pNET patients to receive the antiangiogenic drug \nsunitinib or placebo together with best sup portive care. A statistically significant \ndifference in PFS, the primary end point, was observed with everolimus (11.4 \nmonths) versus placebo (5.5 months), along with increased RR (9.3% vs. 0%, \nrespectively). Recent studies have identified  critical alterations in the signaling \n\nA B C D E F G S24  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\npathways of NETs that may be translated into new therapeutic strategies with \nnovel targeted agents.  \nLearning Objectives:\n1. To learn about the relationship between NET biology, signalling pathways \nand available therapeutics. \n2. To understand current treatment options. \n3. To learn how to contextualise the clinical management of NETs. \nCase presentation and discussion  \n09:35\n08:30 - 10:00 Room N/O  \nInterventional Radiology  \nRC 409  \nEndovascular treatment of acute thoracic \naorta syndrome  \nA-094 08:30 \nChairman's introduction  \nT. Pfammatter; Zurich/CH (thomas.pfammatter@usz.ch) \nThe \"acute aortic syndrome\" includes thre e closely related emergency entities \nof the thoracic aorta: aortic dissection, intramural hematoma and penetrating \natherosclerotic ulcer. As these conditions present with similar symptoms, \ncross-sectional aortic imaging is essenti al for diagnosis, triage and treatment \nplanning. Initial imaging features of th ese pathologies including typical early \ncomplications as well as their differential diagnosis will be reviewed. As \nnowadays several of these patients will undergo early endovascular thoracic \naortic repair, an update on its indication, the different technical options and \ntheir clinical results will follow. Finally, the focus will be on repair-related late \ncomplications and progression of aortic disease. Imaging follow-up protocols, \nfeatures of chronic complications and their interventional repair will be \ndiscussed.  \nA-095 08:35 \nA. Pre-therapeutic radiological evaluation  \nJ. Ferda; Plzen/CZ (ferda@fnplzen.cz) \nThe acute thoracic aorta syndrome covers patients suffering from acute chest \npain and those injured during high-energy trauma. Despite the similar \nsymptoms, the aortic pathologies are heterogeneous, including acute aortic \ninjury, intramural haematoma, aortic dissection, and ruptured thoracic aortic \naneurysm and mycotic aneurysms. The diagnostic approaches could include \nthe whole pallete of the imaging modalities: chest X-ray, transesopheageal \nechocardiography (TEE), multidetector CT angiography (MDCTA), MRI and \nPET/CT. Because of some disadvantages of TEE, like problems with intubation \nin injured patients or problems of MRI with seriously ill patient monitoring, \nMDCTA has become the most used modality due to its ability of discrimination \nbetween aortic and non-aortic pathologies, and also due to its high sensitivity, \nspecificity, availability and especially superior geometrical resolution and \npotential of 3D imaging. The proper pre-therapeutic MDCTA protocol is using \nsub-millimeter isotropic resolution covering the entire aorta with pelvic arteries. \nWhen the pathology of thoracic aorta is found during the triple rule-out triage \nprotocol, additional MDCTA of the rest of  the aorta and pelvic arteries has to \nbe completed. ECG triggering could be an important advantage in the \nreduction of pulsation-derived artefact. The volume of applied contrast material \nused should be as small as possible to plan applications during endovascular \ntreatment. 3D reconstruction of the thoracic aorta with its side branches and \nadvanced vessel analysis have a crucial role in the measurement of the aortic \ndiameter, diameter profile and lengths in the selection of proper stent graft type \nand size.  \nLearning Objectives:\n1. To learn about the best pretreatment imaging modality. \n2. To understand planning and sizing of appropriate stent-graft. \n3. To become familiar with critical criteria and vessel morphology. \nAuthor Disclosure:\n J. Ferda: Speaker; Invited speaker on Somatom World Summit organised by \nSiemens HealthCare 2013. \nA-096 08:58 \nB. EVAR techniques and results  \nF. Fanelli; Rome/IT (fabrizio.fanelli@uniroma1.it) \nEndovascular abdominal aortic an eurysm repair ( EVAR) has gained \nacceptance as a minimally invasive alternative to open surgery in selected \npatients. Many technical improvements have been obtained in the last years \nwith the introduction of new-generation devices. Presenting a lower profile, \nthey can be accommodated even in patients with small vessels and tortuous \nanatomy. Calcified arteries can be no longer considered absolute exclusion \ncriteria. Some devices are designed  to reduce the incidence of endoleaks, \nimproving sealing capabilities by the use of a polymer to better adjust to the \nvariable morphology of the proximal neck or to fill the aneurysmatic sac \ncompletely. More importantly, the introduction of fenestrated devices has \nresolved the problem of facing difficult anatomies when the aneurismatic \npathology involves renal or visceral arte ries. Obviously, the use of these new \ndevices requires a learning curve. Beyond an increase of cost, they permit \ntreating those patients who in the past were considered unfit candidates for \nEVAR. The EVAR new frontier requires performing the procedure in an \noutpatient fashion. A multicentre study was conducted on 100 patients who \nwere discharged 4/6 hours after uncomplicated stent-graft implantation. Cases \n(4%) with access vessel complications required additional procedures and \npatients were hospitalised overnight. The 30-day readmission rate was 4% for \naccess vessel stenosis or false aneurysm. From the time of the first EVAR \nprocedure, significant improvements have been achieved but there is still room \nfor further progress.  \nLearning Objectives:\n1. To understand indications and contraindications for EVAR. \n2. To learn more about the advantages of different types of stent-graft. \n3. To become familiar with percutaneous vascular access. \n4. To learn about the latest trials. \nAuthor Disclosure:\n F. Fanelli: Consultant; WL Gore & Associates, Medtronic, Cook. Speaker; WL \nGore & Associates, Medtronic, Cook, Covidien. \nA-097 09:21 \nC. Imaging follow-up and complications  \nR. Morgan; London/UK (robert.morgan@stgeorges.nhs.uk) \nThe standard imaging modality after endovascular treatment for thoracic aortic \npathology (TEVR) is CT angiography (CTA). CTA enables the radiologist to \nassess for the patency of the endografts, the presence of any complications \nafter TEVR, and the development of any new pathology related not only to the \naorta, but elsewhere above and below the diaphragm. The role of MR is \nreduced compared with CTA, particularly in the presence of stainless steel \nendografts. However, good images can be obtained by MRI and MRA if nitinol \nendografts have been inserted. MR is a useful modality for follow-up in young \npatients who require lifelong follow-up and, therefore, limited exposure to \nionising radiation. Ultrasound has no practical role in the follow-up after TEVR, \nand although plain thoracic radiographs are routinely performed by some \ncentres post-TEVR, in practice almost equivalent information can be obtained \nby CT. The main complications after TEVR are endoleaks, type A dissection, \nparaplegia and stroke. The classification  of endoleaks is similar to the \nclassification fo r EVAR. Ty pe 1 and type 3 endoleaks require treatment by \nadditional endograft coverage with or without supraaortic or visceral artery \nbypass. Other treatment options include the use of branched, fenestrated \nendografts or the use of chimneys and snorkels. Type 2 endoleaks are less \ncommon than post-EVAR. Similar to the EVAR population, intervention is \nmandated for an enlarging aortic diameter and involves embolisation in most \ncases.  \nLearning Objectives:\n1. To learn about available imaging methods for follow-up. \n2. To become familiar with complications and failure of EVAR. \n3. To learn how to treat endoleaks. \nPanel discussion:  \nWhat are the best imaging methods for follow-up?  \n09:44\n08:30 - 10:00 Conf. Room M3  \nProfessional Challenges Session  \nPC 4\nInterventional radiology in oncology  \nA-098 08:30 \nChairman's introduction  \nA. Adam; London/UK (andy.adam@kcl.ac.uk) \nInterventional oncology is a discipline that uses imaging-guided procedures in \nthe treatment of cancer patients. When the malignant disease in not curable, \ninterventional techniques such as biliary and oesophageal stenting can provide \nuseful palliation and improve the patient's quality of life. In patients with \npotentially curable tumours, thermal ablation, cryotherapy and \nradioembolisation provide useful alternatives to radiotherapy and surgery in \ncarefully selected patients. Interventional radiologists who treat patients with \ncancer should practise as clinicians, participating in multidisciplinary meetings \n\nA B C D E F G S25  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nwhere treatment choices can be discussed with specialists from other \noncological disciplines. They should invol ve themselves in all stages of clinical \npractice, including pre-treatment consultations, ward rounds and patient \nfollow-up. Radiation oncology and interventional oncology have much in \ncommon, including the potential for curing  cancer using minimally invasive \ntechniques. Interventional oncologists can usefully adopt many of the principles \nand methods of practice in radiation oncology, including quality assurance and \nthe collection of robust outcome measures. An alliance between these \ndisciplines would be beneficial to clin ical practice and research in both \ndisciplines.  \nSession Objectives: \n1. To understand the contribution of interventional radiology to oncology. \n2. To appreciate the areas of overlap between radiation oncology and \ninterventional oncology. \n3. To understand the need for a clinical pattern of practice in interventional \nradiology in oncology. \nA-099 08:35 \nThe current scope and future challenges  \nJ.I. Bilbao; Pamplona/ES (jibilbao@unav.es) \nTogether with chemotherapy, surgery and radiotherapy, interventional \nradiology (IR) is the fourth pillar in oncology. Transcutaneous and \nendovascular procedures, guided by imaging, constitute a fundamental \nknowledge essential for the multidisciplinary management of oncologic \npatients. The range is wide and covers most of the needs in patient´s care. In \nshort: obtaining samples for making an accurate diagnosis and also to know \nmore about its specific biology (biomarkers); IR covers any possibility needed \nfor vascular access; percutaneous needle ablation is the best alternative in \nselected patients; endovascular embolisation with \"vehiculisation\" of therapies \nis an outstanding method for selective treatment, and sometimes precise \nablation, of different tumors; IR is a unique way to offer palliation in a wide \nrange of tumoral complications, such as embolisation for bleeding, stenting for \nvein obstructions or drainage of fluid collections. There is an obvious need of \ncontinuous technical refinement. Image -guided therapy is a continuous \nprocess that implies many disciplines and that includes every step, from \nstaging through guidance of the procedure to the evaluation of the outcomes, \nboth immediately, during and in the follow-up. Future developments in IR may \nbe focused towards the personalisation of therapies to each patient and to a \nbetter understanding of the biological mechanisms of tumour response or \nprogression and their image expression . Finally, radiologists must be actively \ninvolved in the whole process of clinical trials, from the creation of new lines to \nthe performance of therapy until the evaluation and diffusion of the data.  \nLearning Objectives:\n1. To learn about the range of interventional radiological procedures in the field \nof oncology. \n2. To appreciate the importance of technology and imaging in interventional \noncology. \n3. To learn about likely future developments in interventional oncology. \nAuthor Disclosure:\n J.I. Bilbao: Speaker; Sirtex Medical Europe. \nA-100 08:58 \nHow an oncologist works and why technology alone is not enough  \nL.M. Kenny; Brisbane/AU (lizkenny@bigpond.net.au) \nRadiation treatment has a fundamental role in the multidisciplinary \nmanagement of people with cancer. The evidence base for radiation therapy is \nrobust and approximately 50% of people diagnosed with cancer will benefit \nfrom radiation treatment. Most of this benefit comes from an increase in cure. \nThe technical quality of delivery of radiation treatment is of great importance in \navoiding a geographic miss and also in reducing the amount of normal tissue \nbeing irradiated unnecessarily. As well as the excellent technical delivery of \nany treatment offered, of paramount importance is the intelligent integration of \ncare with attention to evidence base choices for both local and systemic \ntreatment. Multidisciplinary teams are in the best position to integrate surgery, \nradiation treatment, interventional oncology and systemic therapy in a planned \nand deliberate fashion. The members of the team need to understand what \neach has to offer and what choices are available. The full delivery of \nmultidisciplinary care requires input from nursing and allied health. Great \ntechnical care, although critical, is insufficient. Caring for people with cancer \nrequires caring for them as a person and being a competent cancer clinician, \naccepting full clinical responsibility before during and after care. Without this, \nany member of the team is but a technician and the full potential of what they \nhave to offer is likely to be unrealised.  \nLearning Objectives:\n1. To learn about the role of radiation oncology in the local treatment of \ntumours. \n2. To understand the main elements of oncological practice. \n3. To understand the importance of primary clinical responsibility in the care of \npatients with cancer. \nA-101 09:21 \nBest practice: how to organise an interventional oncology unit  \nA. Gangi, J. Garnon, G. Tsoumakidou; Strasbourg/FR (gangi@unistra.fr) \nInterventional oncology is a fast growing field. Interventional oncology is a \nclinical and technical speciality. Solid clinical knowledge associated with the \ntechnical skills is mandatory for a successful practice. The technical skills \nshould be associated to the clinical part. The knowledge of all treatment \nmodalities and the participation of a multidi sciplinary team is vital for the best \npractice. Every single patient should be seen by the interventional oncologist \nand followed-up. The interventional oncologist is part of a multidisciplinary \nteam, taking care of the patient. The team includes oncologists, \nradiotherapists, pain specialists, psychologists, surgeons, and \nanesthesiologists. The interventional on cology unit should include specialised \nnurses, technician, anesthesiologi st, anesthesiologist nurses, and the \ninterventional radiologist. The team should be able to take care of the patient's \nfollow-up and eventual complications. To summarise, high-quality \ninterventional oncology services are essenti al for safe and effective patient \ncare. The technical skills of the interventional oncologist should be associated \nwith an excellent clinical knowledge of the disease. A multidisciplinary team \nwork is mandatory for a successful interventional team. Harmonisation of \ntraining and appropriate credentialing is required for clinical services of the \nbest quality. Interventional radiologists continuously improving their skills and \nknowledge, patient access to safe and effective minimally invasive treatment \noptions is increasing.  \nLearning Objectives:\n1. To learn how to organise an interventional oncology unit. \n2. To understand the clinical role of an interventional oncologist. \n3. To learn how interventional oncologists collaborate with other specialists \ncaring for patients with cancer. \nAuthor Disclosure:\n A. Gangi: Other; Proctoring Galil Medical. \nPanel discussion:  \nInterventional radiology as a new link between oncology  \nand imaging  \n09:44\n08:30 - 10:00 Board Room A  \nSpecial Focus Session  \nSF 4  \nRight heart morphology and function  \nA-102 08:30 \nChairmen's introduction  \nM. Remy-Jardin1, M. Gutberlet2; 1Lille/FR, 2Leipzig/DE\nWhereas cardiac CT and MRI are routi ne examinations for specialised \nradiologists, it has been necessary to wait for the introduction of fast scanning \ntechniques to modify the behavior of nons pecialised radiologists regarding the \ninterpretation of cardiac cavities. The objective of this session is twofold. First, \ncardiac radiologists will underline the role of these imaging modalities in the \nassessment of congenital heart disease but also in ischaemic and \nnonischaemic cardiomyopathies. In the second part of this session, chest \nradiologists will focus on the diagnostic information accessible at the level of \nthe right ventricle, known to be the target of numerous respiratory disorders. \nTwo practical situations will illustrate this approach: pulmonary thromboembolic \nand chronic respiratory diseases. \nSession Objectives: \n1. To make the attendees familiar with the impact of RV dysfunction in various \ncardiac and respiratory disorders. \n2. To describe basic anatomical and functional information that can be \ndeduced from routine cross-sectional imaging. \n3. To underline the pros and cons of dedicated cardiac examinations and those \ncarried out using cardiothoracic imaging. \nA-103 08:35 \nRole of cardiac CT and MRI in assessment of RV in congenital heart \ndisease  \nA.M. Taylor; London/UK (a.taylor76@ucl.ac.uk) \nAccurate assessment of the right ventricle (RV) is crucial for the management \nof congenital heart disease. Echocardiography can provide some information, \nbut as the RV sits directly behind the sternum and as many patients have \nundergone multiple operations, visualisation can be difficult. Furthermore, for \nlong-term follow-up and treatment planning, accurate measurement of \nventricular size and mass, and valvular flow (tricuspid and pulmonary), and \nassessment of anatomy in 3D and 4D are vital. This presentation will outline \n\nA B C D E F G S26  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nthe role of cross-sectional MRI and CT for assessing the RV, and describing \nthe indications, imaging protocols, technical  pitfalls and relevant information for \ntreatment planning.  \nLearning Objectives:\n1. To become familiar with the most frequent congenital heart diseases (CHD) \nin which the RV is involved. \n2. To learn about the most frequent surgical procedures in CHD with right heart \ninvolvement. \n3. To understand which modality to choose and for which CHD. \nAuthor Disclosure:\n A.M. Taylor: Employee; UCL Institute of Cardiovascular Science. Grant \nRecipient; Siemens, UK NIHR, BHF, Heart Research UK,. Research/Grant \nSupport; Siemens - Research agreement. \nA-104 08:53 \nRight heart failure in ischaemic and non-ischaemic cardiomyopathies  \nM. Grothoff; Leipzig/DE (Matthias.Grothoff@herzzentrum-leipzig.de) \nThe role of the right ventricle (RV) has been underestimated for many years. \nToday, we know that the RV is of importance for keeping up a sufficient \ncirculation and that right heart failure in both ischemic and non-ischemic \ncardiomyopathies can result in hemodynamic compromise. RV ischemia has a \nhigher in-hospital morbidity and mortality but post-infarction chronic right heart \nfailure is a rare finding. As the RV has a different physiology from the left \nventricle (LV), also the pathophysiology of ischemia is different here. Using our \nstandard CMR tools T2 weighted imaging for detection of edema and late \ngadolinium enhancement imaging for detection of necrosis/scar we can find \nthat the rate of myocardial salvage is much higher in the RV than in the LV and \nthat RV failure in the acute phase is basically caused by reversible ischemic \neffects. In non-ischemic cardiomyopathies like HCM and DCM changes in the \nRV myocardium mostly resemble changes of the LV. In arrhythmogenic right \nventricular cardiomyopathy/dysplasia (ARVC/D) however, there are specific \nfindings in the RV and the role of imaging in diagnosing ARVC has been \nstrengthened by the revised task force criteria published in 2010. Cine imaging \nshould be performed carefully for detection of RV akinesia, dyskinesia or small \naneurysms as well as the planimetry of the RV. Findings like the detection of \nfibrosis in LGE imaging and the detection of fat in T1 imaging can provide \nadditional information, but are not diagnostic for ARVC.  \nLearning Objectives:\n1. To learn about the different CT and MRI techniques for evaluating right heart \nmorphology and function. \n2. To understand the prognostic impact of right heart involvement in ischaemic \nheart disease. \n3. To learn about the basic morphological and functional features of different \nnon-ischaemic cardiomyopathies. \nA-105 09:11 \nRight heart and chronic respiratory diseases: can CT be used as a one-\nstop-shop?  \nM. Remy-Jardin; Lille/FR (martine.remy@chru-lille.fr) \nOver the last decade, CT technology has evolved towards fast scanning \ncapabilities and high temporal resolution, enabling improved evaluation of the \nheart and surrounding structures in the course of routine thoracic CT imaging. \nThis has progressively modified the radiologist's implication in the interpretation \nof chest CT examinations. Firstly, it is more and more common to integrate the \nphysiological interactions between heart and lung when analysing the CT \nfeatures depicted on a given examination. Secondly, it is now possible to \nintegrate cardiac functional information into a diagnostic CT examination of the \nchest, providing prognostic information in the management of patients with a \nwide variety of chronic respiratory disorders. The purpose of this presentation \nis to provide non-specialised radiologists with some practical guidelines in the \nchoice of the scanning protocols and r ange of functional information that can \nbe deducted from chest CT examinations. Right ventricular dysfunction and \nlevels of pressure within the pulmonary circulation are the key points of such \napproaches. \nLearning Objectives:\n1. To appreciate the clinical impact of a cardiothoracic evaluation from the \nsame CT examination. \n2. To learn about the scanning protocols enabling such a combined analysis. \n3. To understand its compatibility with other non-invasive modalities. \nA-106 09:29 \nRV and prognosis in pulmonary thromboembolic disease  \nN.J. Screaton; Cambridge/UK (Nicholas.Screaton@papworth.nhs.uk) \nRight ventricular failure is the most common cause of early death following \nacute pulmonary embolism and in patients with chronic thromboembolic \npulmonary hypertension. Echocardiography is sensitive in diagnosing and \nquantifying RV dysfunction. CT is the reference standard for the diagnosis of \nacute PE diagnosis and has the potential to provide comprehensive evaluation \nof the pulmonary arteries, heart and lung parenchyma. CT signs of right \nventricular dysfunction which have shown predictive value for adverse outcome \ninclude: flattening of the inter-ventricular septum or bowing towards the left \nventricle, reflux of contrast medium into the IVC, relative RV/LV diameter ratios \non transverse and 4-chamber reconstructions, and ventricular volumetry as \nassessed both on routine non-gated CTPA and ECG-gated CT. In patients with \nCTEPH, MRI permits imaging of the pulmonary vasculature and functional \nevaluation of the right ventricle and pulmonary circulation, enabling both \nmorphological assessment and prognostic evaluation.  \nLearning Objectives:\n1. To learn about clinical and imaging factors associated with prognosis of \nthromboembolic disease. \n2. To understand the benefits and weaknesses of different imaging modalities \nin predicting prognosis in thromboembolism. \n3. To discuss the merits of comprehensive imaging evaluation in the routine \ndiagnostic workup of suspected thromboembolic disease. \nPanel discussion:  \nWhat is the impact of RV function assessment \non patient management?  \n09:47\n08:30 - 10:00 Room P  \nJoint Session of the ESR and EFSUMB  \nAdvances in diagnostic ultrasound: better \nresults through combinations  \nModerators:  \nL.E. Derchi; Genoa/IT \nC.F. Dietrich; Bad Mergentheim/DE \nA-107 08:30 \nUS/MRI fusion to guide prostate biopsies  \nF.M. Drudi; Rome/IT (FrancescoM.Drudi@uniroma1.it) \nPatients should undergo 1.5-3 Tesla MRI using a 6-16 channel surface coil \nplaced over the pelvis or with an endorectal coil. To rperform MRI/TRUS image \nfusion-guided prostate biopsy, MRI s equences should include tri-planar T2-\nweighted imaging, axial diffusion-weighted imaging with apparent diffusion \ncoefficient mapping, 3D point resolved spatially localised spectroscopy and \ndynamic contrast-enhanced axial MRI. MRI/TRUS biopsy is performed with \nelectromagnetic tracking of suspicious lesions identified on MRI. An \nelectromagnetic field generator is placed above the pelvis to allow real-time \ntracking using a probe with a passive electromagnetic tracking sensor. 2D \nTRUS transverse images of the prostate are recorded to render a 3D US \nimage which can be fused with MRI. Suspicious areas identified on MRI are \nimported and manually or semi-automatically fused with the US data set. This \nallows lesions marked on MRI scans to be superimposed on the real-time \nTRUS image. Electromagnetic tracking allows localisation and mapping of \nneedle trajectories in both random and subsequent targeted biopsies. \nIndications for MRI/TRUS image fusion-gui ded biopsy include screening of \npatients at increased risk due to age, elevated PSA blood level and clinical \nsuspicion of prostate cancer. Moreover, this diagnostic method is particularly \nuseful in patients with negative TRUS outcome, as MRI/TRUS fusion permits \ntargeted biopsy of suspicious areas which might have been missed at TRUS.  \nLearning Objectives:\n1. To learn about the technologies needed to fuse US/MRI of the prostate. \n2. To learn how to perform prostate biopsies with US/MRI fusion image \nguidance. \n3. To understand indications for the use of these technologies. \nA-108 08:50 \nCT/US and US/MRI images: are they useful for diagnostic applications?  \nC. Ewertsen; Copenhagen/DK (caroline.ewertsen@dadlnet.dk) \nMultimodality imaging including ultrasound has within recent years been \nintroduced in several anatomical regions. PET, CT and MRI datasets can after \nan initial co-registration be fused and shown either side by side or using \noverlay on screen while doing real-time ultrasound; thus, the PET, CT or MRI \ndataset is reformatted in a projection to fit the real-time ultrasound images. \nSeveral methods of aligning the images are available and have been shown to \nhave a high accuracy. Image fusion involving ultrasound has been tested in \nphantoms, animals and in patient studies, mainly in abdominal imaging. By \ncombining several imaging modalities, it is possible to benefit from the \nstrengths of each modality. It is useful for characterisation of and intervention \non liver lesions, abscesses containing air and lesions in areas with poor \noverview by ultrasound. Also, the method is useful for characterisation and \nbiopsy of PET-positive lesions, especially in patients with a history of cancer. \nThe background of the method and clinical examples, mainly from abdominal \n\nA B C D E F G S27  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\napplications, will be covered. Also, perspectives and future research topics will \nbe highlighted.  \nLearning Objectives:\n1. To learn about the technologies needed to fuse CT/US and US/MRI images. \n2. To understand how to use them in clinical practice. \n3. To understand the indications for these technologies in difficult cases. \nAuthor Disclosure:\n C. Ewertsen: Speaker; Speaker honorarium from GE. \nA-109 09:10 \nImaging tumour perfusion: CEUS compared with CT, MRI and PET  \nN. Lassau; Villejuif/FR (nathalie.lassau@gustaveroussy.fr) \nContrast-enhanced ultrasound (CEUS) has proved to improve the detection \nand characterisation of pathologies compared to conventional ultrasound, CT \nand MRI in a number of indications. Ultrasound contrast agents (UCA), which \nare purely intravascular, do not show any interstitial diffusion or glomerular \nfiltration like iodinated complexes or gadolinium chelates. Dynamic contrast-\nenhanced ultrasound (DCE-US) allows to display the enhancement of a lesion \nwith a high frame rate after bolus or infusion administration of UCA, and to \ncompare enhancement profiles between normal and abnormal tissue. \nQuantification of DCE-US is useful to quantify tumour enhancement and to limit \nintra- and interobserver variability. Mathematical models with several perfusion \nparameters can be used. DCE-US has shown to be of interest after \nantiangiogenic therapies as it allows an earlier evaluation of tumour response \nthan usually done with CT and MRI, which remain mainly based on the \nRECIST criteria. In clinical applic ations, recent mono-centric and multi-centric \nDCE-US studies evaluating anti-angiogenic drugs have demonstrated the \nrelevance of this technique compared to CT and MRI with a significant \ncorrelation with PFS and OS in different types of tumours (HCC, metastatic \nRCC, colon cancer, breast cancer, GIST and melanoma). A consensus paper \nhas been recently published by EFSUMB (European Federation of the \nSocieties for Ultrasound in Medicine and Biology), providing recommendations \nin DCE-US. The development of targeted contrast agents opens the area of \nmolecular ultrasound.  \nLearning Objectives:\n1. To learn how to image tumour perfusion with CEUS. \n2. To compare the results of CEUS with those of CT, MRI and PET. \n3. To understand differences among the techniques, and how to choose from \namong them. \nA-110 09:30 \n3D/4D ultrasonography: tool or toy?  \nM. Claudon1, S.T. Elliott2; 1Vandoeuvre-les-Nancy/FR,\n2Newcastle upon Tyne/UK (m.claudon@chu-nancy.fr) \nThe common perception of 3D ultrasound (US) is of surface-rendered images, \nespecially of the foetus. The same approach, enhanced by new transducer \ntechnology and software, can be used to take ultrasonography to another level \nin general body imaging, providing different image presentations and working \npractices similar to those of CT and MR. The technology involved in a US \nvolume acquisition was represented initially by mechanical 3D transducers, \nand more recently by purely electronic, matrix probes. This latest technology \nallows bi-plane real-time acquisitions, fast switch to volume acquisition up to \n100 degrees, and 4D acquisitions with acceptable frame rates. Protocols have \nbeen described for major abdominal and retroperitoneal organs, with fast \noptimisation of acquisition settings. The technology supports contrast-\nenhanced ultrasound (CEUS). After volume acquisition, interpretation for \nvolume US datasets requires a post-treatment phase, including multi-planar \nreconstruction, multislice imaging, and volumetric analysis. Virtual cystoscopy \nand volume CEUS quantification are new options. The implementation of this \nnew, efficient US modality in a radiology department supposes deep changes \nin the daily practice with delayed post-treatment reporting times. It should \nrepresent a more effective way for comparison between different examinations \nand a better communication tool with clinicians. The proven and potential \nbenefits, in terms of clinical accuracy, training, workflow and overall efficiency, \nwill be discussed.  \nLearning Objectives:\n1. To learn about the technologies available to perform 3D/4D ultrasonography. \n2. To understand their possible role in clinical practice. \n3. To understand the advantages in workflow offered by the use of 3D/4D \nultrasonography. \nAuthor Disclosure:\n M. Claudon: Consultant; Philips Ultrasound. \nPanel discussion:  \nTechnical advances in ultrasonography: it is our responsibility to make \nthem work  \n09:50\n10:30 - 12:00 Room A  \nInteractive Teaching Session  \nE³ 520a  \nPitfalls in abdominal imaging  \nA-111 10:30 \nA. Liver  \nV. Vilgrain, M. Ronot, A. Kerbaol, O. Bruno; Clichy/FR\n(valerie.vilgrain@bjn.aphp.fr) \nThe purpose of this lecture is to emphasise some pitfalls in liver imaging. \nMorphologic changes in the liver are usually attributed to chronic liver disease \nwhere liver cirrhosis represents the most important cause. However, non-\ncirrhotic diseases may also induce atrophy-hypertrophic changes of the liver. \nThe most common mechanisms are related to venous obstruction (either portal \nor hepatic venous) and biliary obstruction. Multidetector CT and MR imaging \nare essential to highlight these abnormalities. When dealing with liver tumours, \nthe most important question that has to be solved is tumour characterisation. \nYet, it is often difficult to assess whether a large tumour is intra- or \nextrahepatic. Imaging findings that might be helpful will be shown. Last, some \nliver lesions can mimic liver tumors. Vascular disorders and focal fatty changes \nor focal fatty sparing are the most common causes. Some other conditions can \nbe also mimickers and such cases will be shown.  \nLearning Objectives:\n1. To learn about morphological changes in the liver observed in non-cirrhotic \ndiseases. \n2. To understand imaging features enabling a distinction between intrahepatic \nand extrahepatic tumours. \n3. To become familiar with liver lesions mimicking liver tumours. \nA-112 11:15 \nB. Pancreas and bile ducts  \nR. Manfredi; Verona/IT (riccardo.manfredi@univr.it) \nThe technique and the anatomy of the bile duct and pancreatic duct will be \ndescribed. The anatomical variants of the biliary duct and the pancreatic duct \nsystem will be analysed and their possible role in generating diagnostic \nimaging pitfalls described. Strategies to avoid pitfalls in diagnostic imaging of \nthe bile duct and the pancreatic duct system will be illustrated, considering the \npossible source of pitfalls. Diagnostic im aging findings of different diseases \ninvolving the biliary ducts and pancreatic duct system will be illustrated, as well \nas the diagnostic imaging criteria useful for the differential diagnosis.  \nLearning Objectives:\n1. To understand the MRI technique for evaluating the pancreatic parenchyma, \nthe pancreatic duct system, the biliary tree, and the functional assessment \nfollowing secretin stimulation. \n2. To become familiar with the signs in MR imaging of the pancreas and bile \nducts. \n3. To understand the diagnostic imaging criteria useful for differential \ndiagnosis. \n10:30 - 12:00 Room B  \nESR meets Russia  \nEM 1\nCrossroads of diagnostic imaging in the \nbig country  \nWelcome by the ESR President  \nG. Frija; Paris/FR \nPresiding:  \nN. Rozhkova; Moscow/RU \nV.E. Sinitsyn; Moscow/RU \nI.E. Tyurin; Moscow/RU \nA-113 10:30 \nIntroduction: Russian radiology today  \nN. Rozhkova, I.E. Tyurin; Moscow/RU\nDiagnostic radiology in the Russian Federation is a fast-growing part of clinical \nmedicine. The implementation of national  projects in health care has led to \nsubstantial improvement in the facili ties of hospitals' modern diagnostic \nequipment. We have 14,189 radiologists and 29,445 technologists working in \n9,000 hospitals. We have about 150 million x-ray-only investigations per year. \nOver the last two years, the number of CT and MRI units has increased by \n\nA B C D E F G S28  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n30%, and modern PET centers and leading centers for radiotherapy have been \nbuilt. We can identify an approximately 20% increase in the number of \nradiological research proj ects--mainly ultrasound, CT, and MRI investigations. \nDuring the last ten years the total number of vascular interventions and MR \nstudies has increased by ten times, four times for CT, and the annual growth of \nUS and x-ray investigations is about 10%. Unfortunately, these technical \ninnovations are not always accompanied with PACS and RIS installations; this \nis a reason why all advantages of digital equipment are not achieved. We see \nrapid development of private medicine; new private hospitals and ambulances \nhave grown by more than 10% and investment companies are looking for new \nprojects in this field. However, the professi onal education of radiologists is not \nenough to work with new diagnostic equipment. This is a reason why in 2014 \nwe will start a pilot project to create a new system of continuing medical \neducation in clinical medicine, including diagnostic radiology. We hope, this \npilot project will increase the efficiency of clinical practise.  \nSession Objectives: \n1. To learn about the organisational structure of radiology in Russia. \n2. To become aware of Russian radiologists' involvement in ESR activities. \n3. To express gratitude to the ESR for inviting Russia as a guest country to the \nECR.\nA-114 10:35 \nCT perfusion in the differential diagnosis of CNS pathology  \nI.N. Pronin; Moscow/RU (pronin@nsi.ru) \nDifferential diagnosis (DD) including tumour and non-tumour brain pathologies \nis an integral part of neuroradiologica l diagnostics and in some cases is a \nchallenge to experienced neuroradiologists. More than 5000 patients with \ndifferent CNS pathologies have been investigated in the Department of \nNeuroradiology, Burdenko Neurosurgical Institute since 2002. In the vast \nmajority of the cases, there were tumours. We used deconvolution method for \n\tBV,\tBF, MTT and PS maps reconstruction on commercially available \nsoftware (Perfusion 1.2.0, 4.0 protocols, ADW, GE). CT perfusion has \ndemonstrated high level of information in determining the degree of malignancy \nin glial brain tumours. A strong correlation between \tBV and PS and tumour \ndegree has been demonstrated. The use of CT-PWI makes it possible to \nsuccessfully carry out DD between radiation necrosis and tumour progression. \nSome histological types of brain lesions are characterised by unique \nhaemodynamic properties which enable using this method as non-invasive \n\"biopsy\". CT-PWI has been especially useful in DD of the skull base region, \nbone and extracranial pathologies. The absence of artefacts created by the \nskull base bones makes this method especially valuable as compared to the \nMRI T2*- and ASL- perfusions. CT- PWI makes it possible to successfully \ndifferentiate tumours and a number of non-tumour CNS lesions including \ndemyelinating diseases, infectious and non-infectious granulomas, etc. CT-\nPWI is a powerful method for differential diagnosis of brain pathology. \tT-PWI \ncan provide unique functional informati on regarding tumour pathophysiology \nand haemodynamics, which are not available with routine CT and MRI.  \nLearning Objectives:\n1. To become familiar with the technique of brain perfusion CT. \n2. To understand the added diagnostic value of perfusion CT. \n3. To learn about input of CT perfusion for assessment of treatment. \nA-115 10:55 \nInterlude: Development and use of web-based teleradiology in Russia  \nO.S. Pianykh; Newton Highlands, MA/US (opiany@gmail.com) \nThe largest territory in the world, Russia, presents a perfect teleradiology use \ncase of extremely unevenly distributed health care, concentrated in Moscow \nand spread thin outside over an enormous area and sparse population. This \nunevenness deeply affects the quality and avai lability of radiological services, \nand cries out for efficient and practical teleradiology solutions. However, the \nsame unevenness in medical expertise, financing and IT infrastructure \nfrequently acts against the advancement of teleradiology projects, blocking \ntheir natural progress. As a result, techni cal, financial, educational and clinical \nmatters, interleaved into the nascent Russian teleradiology ventures, require \nserious and predictable solutions, based on analysis and adaptation of already \ndeveloped, internationally proven strategies. Currently, Russian teleradiology \nsimply takes advantage of whatever is available to make its progress better, \nbut needs to develop itself up to the tasks it faces.  \nA-116 11:00 \nTuberculosis in Russia: a challenge for a national radiological service  \nI.E. Tyurin; Moscow/RU (igortyurin@gmail.com) \nApproximately, 1.7 billion people worldwide are infected with Mycobacterium \ntuberculosis, of which 20 million are active cases. The reasons for resurgence \nof TB infection include the HIV epidemic, a rise in reactivation disease in the \nelderly, a growing migrant population and spread of drug-resistant strains. The \nincidence of atypical TB infection is also on the rise, of which Mycobacterium \navium intracellulare is the most important human pathogen. The pathologic \nform of the pulmonary infection depends on the sensitivity of the infected host \nand is classified as primary or postprimary. Primary TB pattern represents \ninfection resulting from recent contact with the pathogen. Postprimary TB \npattern results from reactivation of a dormant focus within the lungs. Thoracic \ntuberculosis produces a broad spectrum of radiographic abnormalities. The \nradiological patterns had been described as parenchymal, airway, vascular, \nmediastinal, pleural, and chest wall lesions. Common causes of a missed \ndiagnosis of thoracic tuberculosis are failu re to recognise hilar and mediastinal \nlymphadenopathy as a manifestation of primary disease in adults, overlooking \nof minimal productive lesions or reporting them as inactive, and failure to \nrecognise that an upper lobe or superior segment of lower lobe mass might be \ntuberculosis. In AIDS patients, the imaging features depend on the degree of \nimmune suppression. A pattern of postprimary TB is also usually seen among \npatients with decreased immunity due to alcoholism, renal failure, diabetes \nmellitus, ageing, malignancy, and renal and cardiac transplantation.  \nLearning Objectives:\n1. To understand the scope of the problem with tuberculosis screening in the \nRussian Federation. \n2. To learn about the changing imaging patterns of thoracic tuberculosis. \n3. To appreciate the current role of imaging in the differential diagnosis and \nfollow-up of this pathology. \nA-117 11:20 \nInterlude: Mystery of Denisov's cave and paleoradiology  \nM. Mednikova; Moscow/RU (medma_pa@mail.ru) \nThis study focuses on the anatomical identification of fossil bones from Altai \nhighland in Southern Siberia, their radiological description, and parallels \namong other hominin fossils. Methods describe the small and isolated tubular \nbones. We used microCT VersaXRM-500 by Xradia Inc. and digital microfocus \nx-ray. Denisova Cave is the best studied Paleolithic cave in North Asia. \nArchaeological data suggest that about 300 thousand years before the present, \na group of humans migrated to Southern Siberia from the west. Their \ndescendants had lived in the Altai Mountains in relative isolation for 250 \nthousand years. The taxonomic status of the early inhabitants of Southern \nSiberia was clarified thanks to palaeogenetic studies. It was concluded that the \nAltai hominin was genetically twice further from modern humans than were \nNeanderthals. Phylogenetic analysis suggests that this clade diverged from \nthat ancestral to humans and Neanderthals very early - about 1 billion years \nago. Descendants of this clade apparently survived in the Altai refugium until \nthe period 50 - 40 thousand years ago. Due to structural patterns of preserved \npedal and manual phalanxes, humans from Denisova Cave could be expected \nto be the bearer of \"archaic\" traits. The ex traordinarily thick walls of tubular \nbones in adults reflect a high level of occupational stress. Radiological \nvolumetric microscopy of the Denisovan girl phalanx gave evidence for the \nhistological estimation of the developm ental age. Radiological methods seem \nto be the perspective approach in the study of rare and fragmentary fossil \nhuman remains, differentiating between archaic and modern humans.  \nA-118 11:25 \nAdvances in imaging of pancreatic masses  \nG.G. Karmazanovsky; Moscow/RU (karmazanovsky@ixv.ru) \nModern diagnostic radiology allows not  only to detect pancreatic tumours, but \nalso to carry out their differential di agnosis with high accuracy. This is \nespecially important because many benign tumours of the pancreas do not \nrequire immediate surgery. At the same time, many benign tumours may \nbecome malignant. The differential diagnosis of the pancreatic cystic lesions \nusing endoscopic ultrasound and magnetic resonance \npancreaticocholangiography has now become particularly accurate. Contrast \nenhancement allows detecting signs of tumor invasion into the main blood \nvessels and adjacent organs. Modern developments of radiology help to use \nextended operations for malignant tumours and sparing surgery with minimal \nremoval of intact functioning pancreatic tissue in benign tumours.  \nLearning Objectives:\n1. To become familiar with major types of pancreatic masses and their \nradiological manifestations. \n2. To understand approaches to the selection of diagnostic pathways in \npancreatic tumours. \n3. To become acquainted with new developments in diagnostic imaging of \npancreatic tumours. \nA-119 11:45 \nInterlude: An artistic view of CT  \nA.L. Yudin; Moscow/RU (prof_yudin@mail.ru) \nRadiology is a specialty based largely on figurative perception of diagnostic \nimaging. The radiological picture of many symptoms reminds one of objects \nand environmental phenomena (for example, vanishing lung, draped aorta, \ngeographic liver, porcelain gallbladder, dirty fat and others). Training of \ncreative mentation promotes lasting assim ilation of educational material at the \n\nA B C D E F G S29  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nassociative level. Metaphorical thinking skills can also be improved by \nsearching for amusing fragments in radiological images similar to the objects in \neveryday life; animals, cartoon characters, and others. The essential help in \nthe study of the physical foundations of radiology and functional capabilities of \nworkstations provide the execution and study of X-ray films, CT or MRI of fruits \nand vegetables, flowers, various artifacts an d other objects in the environment. \nEventually, it is just beautiful.  \nPanel discussion:  \nFuture developments in Russian radiology: which path to take?  \n11:50\n10:30 - 12:00 Room E2  \nFoundation Course: Breast Imaging  \nE³ 520b  \nBreast US  \nModerator:  \nR. Schulz-Wendtland; Erlangen/DE \nA-120 10:30 \nA. Clinical US technique (2D and automated)  \nG. Ivanac; Zagreb/HR (gordana.augustan@zg.t-com.hr) \nUltrasound of the breast is an established imaging technique with several \nadvantages. It has been used to differentiate solid from cystic breast lesions for \na long time. It has also been increasingly used to visualise small lesions in \nmammographically dense breasts and is the initial imaging method of the \nbreast in young women. The features of the lesions that need to be analysed \nare: shape, relation to anteroposterior to laterolateral diameter, margins, \ninternal structure and absorption of sound (distal acoustic phenomena). Color \nDoppler enables the thorough assessment of flow within the breast lesions. \nElastography is established as a useful method to differentiate breast lesions \non the basis of their stiffness, which can be quantified. The accurate staging of \naxillary disease is an important aspect in the management of patients with \nbreast cancer. It is recognised, however, that underlying malignancy can be \nfound in lymph nodes that appear morphologically normal. A variety of \nmorphological features that may be seen in pathological nodes have been \ndescribed (cortical thickness of > 3.5 mm and absence of a fatty hilum). The \nautomated breast ultrasound technique has been known for a long time, but \nwith recent improvements now may play an important role. The automated \nbreast volume scanner (AVBS) employs frequencies of 5-14 MHz. AVBS has \nvarious major advantages, such as being independent of the experience of the \noperator as well as supplying consiste nt and reproducible res ults. Additionally, \nfor the first time it has become possible to obtain coronal images of the \ncomplete breast, which greatly assists in the planning of surgical interventions.  \nLearning Objectives:\n1. To understand the role of US in lesion characterisation. \n2. To become familiar with the principles of axillary lymph node status \nassessment. \n3. To learn about automated 3D US. \nA-121 11:00 \nB. US of the breast and axilla  \nC.F. Weismann; Salzburg/AT (christian.weismann@inode.at) \nTo study the technical basics in breast ultrasound (US), a breast scanning \nphantom helps to understand different US settings of greyscale imaging. \nTypically, breast US work has a linear array transducer with a minimum field of \nview of 3.8 cm and a high frequency of minimum 7 MHz. A broadband \ntransducer (e.g. 6-16 MHz) with different bands is preferred. In the central \naxillary area, a lower frequency band offers a deeper penetration depth. High \nfrequencies improve the tissue contrast and optimise the axial and lateral \nresolution. The transmitter focus is adapted to the region of interest. Highly \nsensitive color Doppler detects slow flow rates (1 cm/s and less). For \nfrequencies and power settings used in diagnostic greyscale and color Doppler \nstudies, no safety limitations have to be considered. Breast US is mainly used \nas a second-line imaging tool to mammography (MG). A correlation between \nboth imaging modalities is crucial. Skin markers and additional MGs may help \nto solve the correlation problem. In BI-RADS 4 or 5 US lesions with unclear \ncorrelation in MG, a marker placement after US-guided large-core needle \nbiopsy helps to clear the problem. The pathomorphological growth pattern of a \nlesion is the basis to understand different imaging aspects with different \nmodalities. Second-look US after MRI is an important correlation of lesions, \nwhich were first visible with MRI. Understanding the complementary imaging \ncriteria will help to reduce the number of false-positive results. \nLearning Objectives:\n1. To understand basic technical and safety considerations. \n2. To learn about radio-pathological correlations. \n3. To become familiar with possible ways to decrease the number of biopsies. \nA-122 11:30 \nC. Sonoelastography and ancillary modalities  \nC.S. Balleyguier, S. Canale, L. Ciolovan, C. Dromain; Villejuif/FR\n(balleyguier@igr.fr) \nUltrasonography (US) B-mode is an established and powerful imaging tool in \nthe diagnosis of breast tissue abnormalities. US provides a high degree of \nsensitivity in differentiating malignancie s, nevertheless, false positive results \nrepresent a drawback for US. Elastography imaging has been shown to \nimprove specificity of the US evaluation of breast masses, in evaluating tissue \nstiffness. Most common elasticity imaging techniques are represented by free-\nhand elastography, with requires manual compression on a lesion with the \nultrasound probe. This technique is easily feasible with a learning curve, but \nremains dependant of the operator. Shear-wave elasticity imaging is a new \ntechnology which provides qualitative and quantitative analysis on a lesion, \nless dependant on the operator. Performances of shear-wave elasticity may \nimprove breast lesion characterisation and help to better categorise \nundetermined lesions such as Bi-Rads 4a and 3 nodules. Elasticity imaging \ncharacteristics will be added in the new version of Bi-Rads ultrasound lexicon. \nElasticity imaging principles with an ov erview of the different elasticity modes \nwhich may be used will be presented during this session.  \nLearning Objectives:\n1. To get acquainted with ancillary modalities. \n2. To learn about radio-pathological correlations. \n3. To appreciate the future use of ancillary modalities. \n10:30 - 12:00 Room F1  \nJoint Course of ESR and RSNA (Radiological Society  \nof North America): Emergency Radiology  \nMC 522  \nCNS emergencies  \nModerators:  \nS.E. Mirvis; Baltimore, MD/US \nA. Palko; Szeged/HU \nA-123 10:30 \nA. CNS trauma and neurovascular injury  \nH.A. Rowley; Madison, WI/US (hrowley@uwhealth.org) \nA practical imaging approach to brain and neurovascular trauma will be \nreviewed, with an emphasis on understanding the correlation between \npathophysiology and imaging signs. Guidelines on when to order acute \nneurovascular studies will be presented. Special technical considerations to \nhelp optimise CT and MR imaging protocols for suspected brain injury, CNS \nhaemorrhage, and arterial dissection will be discussed.  \nLearning Objectives:\n1. To become familiar with traumatic brain injury demographics and \nclassification schemes. \n2. To learn how to apply appropriateness criteria for head trauma imaging to \nchildren and adults. \n3. To identify key imaging patterns and pitfalls in the evaluation of brain and \nneurovascular trauma. \nAuthor Disclosure:\n H.A. Rowley: Consultant; GE, Bracco, Guerbet, Gore, Genentech, and \nLundbeck. \nA-124 11:00 \nB. CNS non-traumatic emergencies  \nM. Smits; Rotterdam/NL (marion.smits@erasmusmc.nl) \nNeurological emergencies are often associated with high morbidity and \nmortality, and thus require prompt diagnostic and therapeutic action. Non-\ntraumatic emergencies may however have a subacute onset, and radiological \nsigns may be subtle, which can lead to delay in diagnosis and treatment. Since \nclinical features are often nonspecific, the radiologist may be the first to point \nthe clinician in the direction of the correct diagnosis. It is therefore of great \nimportance that the radiologist is aware of and familiar with the various imaging \nfindings, on both computed tomography (CT) and magnetic resonance imaging \n(MRI), of non-traumatic neurological emergencies. These include vascular, \ninfectious and inflammatory diseases. Commonly encountered emergencies \nare ischaemic and haemorrhage stroke, venous thrombosis, arterial dissection, \nabscess, acute disseminated encephalomyelitis (ADEM), and encephalitis. \n\nA B C D E F G S30  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nRadiological findings in rarer diseases may mimic those in the more commonly \noccurring diseases, but need to be correctly interpreted as therapeutic \nstrategies and prognosis may be entirely different. Such entities include for \ninstance posterior reversible encephalopathy syndrome (PRES), reversible \ncerebral vasoconstriction syndrome, Susac's syndrome, and status epilepticus. \nFurthermore, initial findings of (impending) complications of brain disease, \nsuch as hydrocephalus and herniation of brain structures, may be subtle, while \nearly recognition allows for prompt and adequate intervention. Finally, \ndiagnostic and therapeutic interventions performed in an emergency setting \nmay interfere with the diagnosis and interpretation of clinical and imaging \nfindings. Associated limitations and pitfalls  therefore need to be recognised to \navoid false-negative or false-positive diagnosis, respectively.  \nLearning Objectives:\n1. To learn about the modalities (CT/MRI) and protocols for non-traumatic \nneurological emergencies. \n2. To learn how to diagnose the main non-traumatic neurological vascular and \nnon-vascular emergencies. \n3. To become aware of the pitfalls and limitations of clinical presentation and \nimaging findings in non-traumatic neurological emergencies. \nA-125 11:30 \nC. Interactive case discussion  \nH.A. Rowley1, M. Smits2; 1Madison, WI/US, 2Rotterdam/NL\nBrain and neurovascular trauma cases will be reviewed in an interactive \nformat, with an emphasis on understanding the correlation between \npathophysiology and imaging signs. Imaging 'pearls and pitfalls' will be \npresented using a variety of CT and MR examples. Guidelines on when to \norder and how to perform acute neurovascular studies will be illustrated. \nSpecial technical considerations to help optimise CT and MR imaging protocols \nfor suspected brain injury, CNS haemorrhage, and arterial dissection will be \nhighlighted through use of memorable case examples.  \nLearning Objectives:\n1. To learn about traumatic brain injury (TBI) and non-traumatic neurological \nemergencies. \n2. To become familiar with imaging manifestations of TBI and non-traumatic \nneurological emergencies. \n3. To understand the clinical implications of radiological imaging findings in TBI \nand non-traumatic neurological emergencies. \n4. To learn about the state-of-the-art radiological imaging options for the \nassessment of acute TBI and non-traumatic neurological emergencies. \nAuthor Disclosure:\n H.A. Rowley: Consultant; GE, Bracco, Guerbet, Gore, Genentech, and \nLundbeck. \n10:30 - 12:00 Room P  \nESR Radiation Protection Session  \nLaunch of ESR EuroSafe Imaging \nCampaign: dealing with challenges of \nradiation protection  \nModerators:  \nC. Owens; London/UK \nP. Vock; Spiegel/CH \nA-126 10:30 \nESR EuroSafe Imaging Campaign  \nM.M. Rehani; Vienna/AT (madan.rehani@gmail.com) \nThe current century has brought with it new challenges in radiation protection, \nmany of which follow the development of MDCT which greatly enhanced \ndiagnostic capabilities and substantially reduced scanning time to just a single \nbreath-hold for chest CT, making CT scanning both patient-friendly and the \nphysician's preferred tool. CT has also been added to nuclear imaging systems \nto create hybrid scanners (PET/CT; SPECT/CT). Skin injuries to patients from \nCT were for the first time reported in 2005-2009. Surveys in many countries in \nEurope and elsewhere show wide vari ations in the radiation dose given to \npatients for a particular radiological examination, and there are an increasing \nnumber of reports of inappropriate examinations. ESR has recently published \nits position statement on Insights into Imaging on GPS implying: Globalisation \n(detailing all the steps and involving all stakeholders), Personalised medicine \nand Safety. The EuroSafe Imaging will involve a number of actions, including: \n1. Survey of paediatric CT practices in European countries. 2. EuroSafe \nImaging Posters for ECR 2014. 3. Developm ent of individual 10-point lists of \ncriteria for safe radiological examinations for CT, mammography, radiography, \netc. Additionally, the criteria for each examination will be applied to specific \nbody parts. The intention is to make the criteria available in all European \nlanguages. 4. Orienting chairs and senior radiologists on radiation protection. \n5. Session at ECR 2014 to announce EuroSafe Imaging campaign. 6. A \ncolumn on radiation protection in each issue of the ESR's Newsletter. 7. \nActions for residents and fellows using soci al media. 8. Certification: Is your \nimaging EuroSafe?  \nLearning Objectives:\n1. To learn about the ESR's new EuroSafe Imaging campaign. \n2. To understand the issues that require a European campaign. \nA-127 10:40 \nImage Gently Campaign  \nM.J. Goske; Cincinnati, OH/US (marilyn.goske@cchmc.org) \nImage Gently 5 years later: Lessons learned in radiation protection for children. \nThe Alliance for Radiation Safety in Pediatric Imaging was founded in 2007 to \npromote radiation protection for children worldwide through awareness, \neducation and advocacy. Comprising over 75 medical professional societies \nand agencies, the Alliance seeks to change practice locally for improved \npaediatric patient safety in medical imaging. Since its inception, the Alliance \nhas had 6 campaigns in CT, diagnostic and interventional radiology, nuclear \nmedicine, digital radiography and an outreach campaign to parents and 3 \neducational summits. Yet, there is still work to be done. There is a need for \nparents and patients to receive information about their imaging test prior to the \nperformance of imaging procedures, parti cularly those involving ionising \nradiation. The paediatric medical imaging community should work tirelessly \nwith the manufacturers of imaging equipment to tailor equipment for children to \noptimise the study and ensure that the users of the equipment are \nknowledgeable in its safe use in children. The routine display of size-specific \ndose estimate on CT scanners will better estimate patient dose for quality \nimprovement within facilities and in dose registries. Finally, there is a need for \ndiagnostic reference levels in paediatric radiology. This presentation will \nupdate the audience in progress to date regarding these challenges.  \nLearning Objectives:\n1. To learn about the Image Gently Campaign for radiation protection of \nchildren. \n2. To understand the lessons learnt while communicating messages. \nA-128 10:50 \nImage Wisely Campaign  \nJ.A. Brink; Boston, MA/US (JABRINK@partners.org) \nThe Image Wisely programme continues to move forward, guided largely by its \nsteering committee, composed of two representatives each from ACR and \nRSNA and one representative each from AAPM and ASRT. The Image Wisely \nwebsite (www.imagewisely.org) has educational content for imaging \nprofessionals (radiologists, medical phys icists, and technologists) and referring \nphysicians. A patient tab features links to radiologyinfo.org and the Image \nGently website. A tab for \"My Equipment\" links visitors to radiation dose-related \n'microsites' developed by GE, Hitachi, Philips, Siemens and Toshiba. As of \nAugust 29, 2013, 18,646 individuals, facilities and associations have taken the \nImage Wisely pledge. To attract traffic to its website, Image Wisely has recently \ninstituted 'News' and 'Top Reads' sections on the splash page highlighting \nrecent articles and announcement, highlighting breaking news coverage and \njournal publications on relevant topics. In 2012, content on nuclear medicine \nprocedures was finalised, completing two of the three targeted foci of the initial \naction plan_CT and nuclear medicine. In October 2013, a launch meeting will \ninitiate the process of developing content for the third target area, fluoroscopy. \nIn 2012 and 2013, Image Wisely has concentrated on efforts to engage \nreferring physician communities, with parti cular interest in paediatricians and \nemergency medicine physicians. Progress has been slow, but has recently \ngained traction with emergency medicine in the form of radiologist participation \nin a 2015 symposium, Diagnostic Imaging in the Emergency Department: A \nResearch Agenda to Optimise Utilisation, organised by the Society of \nAcademic Emergency Medicine.  \nLearning Objectives:\n1. To learn about the Image Wisely Campaign for radiation protection of adults. \n2. To understand the lessons learnt while communicating messages. \nA-129 11:00 \nLessons from a national approach to patient safety in radiation protection  \nP. Cavanagh; Taunton/UK (petecavanagh@gmail.com) \nIn considering a European campaign on radiation awareness, it is useful to \ngain information from similar campaigns in health care. There have been a \nnumber of national patient safety campaigns based on the Institute for \nHealthcare Improvement (IHI) 100,000 lives campaign initiated in the USA in \n2006. Following the success of this, a similar campaign was launched in \nEngland. Part of this process included an analysis of the success of the \nprogramme and the key interventions and drivers that were considered \nessential at both the national and local level. These included strong leadership, \n\nA B C D E F G S31  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nmeasurable outcomes, continual effective communication and support as well \nas a clear package of evidence-based interventions.  \nLearning Objectives:\n1. To learn about the national patient safety campaign in the UK. \n2. To understand the lessons learnt during the national campaign. \nA-129/1 11:10 \nCurrent challenges for radiation protection research in Europe \nJ. Repussard; Paris/FR  \nPanel discussion  11:20\nModerator: L. Bonomo; Rome/IT \nPanellists: \nM.M. Rehani; Vienna/AT, M.J. Goske; Cincinnati OH/US, J.A. Brink; Boston, MA/US, \nP. Cavanagh; Taunton/UK, J. Repussard; Paris/FR \nEuropean Commission, G. Simeonov; Luxembourg/LU \nIAEA, R. Chhem; Vienna/AT \nWHO, M. del Rosario Perez; Geneva/CH \nHERCA and Federal Office for Radiation Protection (Bfs), J. Griebel; Munich/DE \nArt. 31 Group of Experts/ICRP, E. Vano; Madrid/ES \nCOCIR, N. Denjoy; Brussels/BE \nEFRS, G. Paulo; Coimbra/PT \nEFOMP, J. Damilakis; Heraklion/GR \nCIRSE, W. Jaschke; Innsbruck/AT \n12:30 - 13:30 Room E2  \nThe Beauty of Basic Knowledge: Skeletal Radiology  \nMC 26B  \nTumoural and pseudotumoural MSK \nlesions  \nModerator:  \nV.N. Cassar-Pullicino; Oswestry/UK \nA-130 12:30 \nTumoural and pseudotumoural MSK lesions  \nK. Verstraete; Ghent/BE (koenraad.verstraete@ugent.be) \n1. Bone (pseudo)-tumours: The majority of bone tumours can be detected on \nplain radiography. The age of the patient, location of the tumour in a bone and \nhistory of pre-existing bone abnormality should be included in determining the \nlikely diagnosis. Careful analysis of pattern of bone destruction, periosteal \nreaction and matrix mineralisation allow for characterisation of most bone \ntumours and differentiation from pseudotumours. CT may be useful for osteoid \nosteoma and MRI is the best imaging technique for further diagnosis and \nstaging by displaying tumour composition and extent of bone marrow \ninvolvement, including skip lesions, presence and extent of extraosseous soft \ntissue mass, and involvement of neurovascular bundle, muscle compartments \nand adjacent joint. This allows to find the best biopsy and surgical approach. \nTo evaluate local control of disease and for detection of local recurrence, MRI \nis usually the best imaging technique. 2. Soft tissue (pseudo)-tumours: The \nmajority of soft tissue tumours can be detected on ultrasound. Except for cysts \nand subcutaneous lipoma, MR will be the next imaging technique for diagnosis, \nlocal staging, and eventually to find the best biopsy and surgical approach. The \nage of the patient, location of the tumour and careful analysis of the signal \ncharacteristics on MRI allow for characterisation of many soft tissue tumours \nand differentiation from pseudotumours. Plain radiography and CT may be \nuseful for detection of calcifications and myositis ossificans. To evaluate local \ncontrol of disease and for detection of local recurrence, ultrasound and MRI \nare the best imaging techniques.  \nLearning Objectives:\n1. To become familiar with the common pathological features of bone and soft \ntissue tumoural lesions. \n2. To appreciate the imaging hallmarks of pseudotumoural bone and soft tissue \nlesions. \n3. To learn how best to use imaging modalities in differential diagnosis. \n12:30 - 13:30 Room F1  \nThe Beauty of Basic Knowledge: Interventional Radiology  \nMC 25B  \nPercutaneous drainages and \nnephrostomies\nModerator:  \nM. Bezzi; Rome/IT \nA-131 12:30 \nPercutaneous drainages and nephrostomies  \nR. Portugaller; Graz/AT (rupert.portugaller@medunigraz.at) \nImage-guided catheter drainage is regarded to be effective if fluid collections \nare infected, produce symptoms or communicate with fistulas. Coagulopathy \nand the lack of a safe puncture access route represent contraindications. In the \nfirst scenario, coagulation factors are mostly helpful and in the second hydro-\ndissection may be applied to oust organs from the access route. The clinical \nsuccess of catheter drainage is achieved in about 85%. Complications like \nseptic shock, haemorrhage and bowel or pleural transgression were reported \nin up to 10%. Criteria for catheter removal comprise improvement of clinical \ncondition, laboratory results and resolution of the cavity in the absence of a \nfistula. The amount of drained fluid should decrease beyond 10 ml to 20 ml/24 \nhours. Percutaneous nephrostomy is mostly performed to relieve the urinary \ntract from benign or malignant obstructions, urinary leakage or fistulas, or to \nobtain access to the collecting system for manipulations like stone \ndisintegration and removal. Technical success rates of approximately 98% \nwere reported for obstructed collecting systems, whereas the success declined \nto 85% in non-dilated tracts. Severe complications like septic shock and \ntransfusion-demanding haemorrhage occur in 1.3% to 1.8% and 2% to 4%, \nrespectively. In case of pyonephrosis, the rate of septic shock can be as high \nas 7%. To prevent encrustation of the nephrostomy catheters, outpatient \ncatheter exchanges are usually scheduled at 8-week intervals. If the urinary \nbladder function is preserved, antegrade double-j ureter-stent insertion via the \nnephrostomy access may be reasonable. Then, every 3 months transvesical \nstent exchange is recommended.  \nLearning Objectives:\n1. To understand the indications for percutaneous fluid drainage and \nnephrostomy. \n2. To learn the various imaging modalities for guidance and basic techniques. \n3. To appreciate the efficacy of the procedures and the appropriate follow-up. \n12:45 - 13:15 Room A  \nPlenary Session  \nHL 1  \nJosef Lissner Honorary Lecture  \nPresiding:  \nV.E. Sinitsyn; Moscow/RU \nA-132 12:45 \nResearch in cardiac imaging: how I do it  \nA. de Roos; Leiden/NL (A.de_Roos@lumc.nl) \nIn this honorary lecture, I will review a number of personal impressions that \nmay contribute to the successful performance of research projects in \ncardiovascular radiology. Also, issues and obstacles in performing successful \nresearch in the field of radiology will be considered. Key factors for success \ninclude guidance by inspiring mentor, genuine interest and motivation, some \ncreativity and serendipity. Radiology has developed tremendously with many \ninnovative modalities over the last 25 years, providing ample opportunity to \nparticipate in clinical research. Potential issues that should be addressed are \nsubspecialisation, turf battles, competition from other clinicians/ imaging \nspecialists and adequate training in r adiology research. The field of imaging \nresearch includes traditionally more clinic ally oriented research by focussing on \ndeveloping and testing of new modalities and applications, now becoming \nmore basic by including molecular imaging, population imaging, outcome \nstudies and alike.  \nLearning Objectives:\n1. To learn about personal impressions how to succeed in research. \n2. To learn what makes research exciting.  \n\nA B C D E F G S32  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n14:00 - 15:30 Room E2  \nFoundation Course: Breast Imaging  \nE³ 620  \nMRI of the breast  \nModerator:  \nF. Pediconi; Rome/IT \nA-133 14:00 \nA. Technique and diagnosis  \nK. Kinkel; Chêne-Bougeries/CH (karen.kinkel-trugli@wanadoo.fr) \nMRI of the breast is ideally performed during the second week of the cycle (day \n7-14) when hormonal glandular background enhancement is minimal. The \nprotocol includes T2-weighted imaging for anatomical purposes and T1-\nweighted images for the detection of breast cancer after intravenous injection \nof contrast media. Fat suppression techniques are important to visualise the \nenhancing lesion in the presence of T1 high signal intensity fat. Subtraction \ntechniques (postcontrast image minus precontrast image) require no motion \nartefact which is obtained through dedicated breast coils with gentle breast \ncompression. Spectral fat suppression is another fat suppression technique \noften used in 3D sequences allowing for high spatial resolution. Lesion \ncharacterisation relies on both morphology and kinetic enhancement \ncharacteristics over time. Spiculated borders, rim enhancement and segmental \nor irregular linear enhancement are typical morphological features of breast \ncancer, whereas washout kinetic demonstrates  high positive predictive value of \ncancer. Lesion interpretation takes into account the patient's age, hormonal \nstatus, personal risk for breast cancer and hi story of current medical, surgical \nor radiation therapy. Comparison with prior im aging studies is crucial to identify \nbenign stable disease of the breast and MRI-only lesions changing patient \nmanagement. Suspicious MRI-only lesions not identified at second-look \nultrasound will undergo MRI-guided biopsy with clip positioning.  \nLearning Objectives:\n1. To learn how to do it. \n2. To learn how to read the images. \n3. To understand which patients can benefit from it. \nAuthor Disclosure:\n K. Kinkel: Research/Grant Support; Clinique des Grangettes. \nA-134 14:30 \nB. MRI of the postoperative breast  \nA. Tardivon; Paris/FR (anne.tardivon@curie.net) \nSilicone-filled implants (single or double lumen) require a dedicated sequence \nwhere silicone exhibits a high signal intensity, whereas signals from fatty and \nfibro-glandular tissues are cancelled. Diagnosis of intracapsular rupture relies \non the detection of a linguine sign (direct sign) or multiple \"key-hole\" and/or \" \nteardrop\" images (indirect signs). Extracapsular rupture is defined as the \npresence of silicone outside the capsule (breast, soft tissues, lymph nodes). \nBreast reconstruction after mastectomy may involve autologous tissue flaps \n(skin, fatty tissue, muscle and fascia). The transferred muscle is inserted in \nfront of the major pectoralis muscle and enhances after contrast medium \ninjection. The most common benign findings seen in such reconstructed \nbreasts and also after a breast-conserving treatment are oedema, seroma, \nhaematoma, fat necrosis and fibrosis. Diffuse thickening of the skin and \ntrabeculae is usually observed the first year after completion of radiation \ntherapy. Small focal areas (less than 5 mm) of non-mass-like enhancement \nand thin linear or rim enhancement at the lumpectomy site can all be expected \nfindings. These benign findings decrease progressively, but residual \nenhancement may be observed in 15% of women at 5 or more years. In \npatients who were switched from tamoxifen to aromatase inhibitors, a stronger \nor re-appearance of a background enhancement may be observed. Before \nclassifying such findings as benign or pr obably benign, clinical examination \nand standard imaging data must be taken into account. Highly suspicious \nlesions in such patients are similar to BI-RADS 5 lesions in the nontreated \nbreast.  \nLearning Objectives:\n1. To understand the MRI technique used. \n2. To become familiar with different implant types. \n3. To learn when to raise the flag. \nA-135 15:00 \nC. MRI in the high-risk population  \nC.K. Kuhl; Aachen/DE (ckuhl@ukaachen.de) \nPrevention strategies for women at high lifetime risk of breast cancer are \nusually adapted to the individual woman's risk of breast cancer. Women at high \nrisk (BRCA mutation carriers or women with a 30% likelihood of BRCA-\nheterzygosity) are offered primary prevention, which includes chemoprevention \nby Tamoxifen or surgery (risk-reducing mastectomy and/or salpingo-\noopherectomy, where the latter also helps reduce the risk of subsequent breast \ncancer by 30%). If women opt for secondary prevention (active \nsurveillance/screening), this has to start at 30 at the latest. MRI is considered a \ncompulsory component of all programs worldwide. Due to the very limited \nadded cancer yield of mammography in this subset of women, and because of \nthe still unsettled issue of possibly increased radiosensitivity of BRCA-mutation \ncarriers, mammographic screening is not recommended until the age of 40. \nThere is broad agreement that (at least) an annual screening is important; \nespecially for BRCA1 mutation carriers, screening every 6 months may be \nmore appropriate. We recommend interleaved screening, with annual MRI and \nannual ultrasound ( ± mammography) phase-shifted by 6 months. There are \nimportant differences between BRCA1- and BRCA2-associated cancers in \nterms of age distribution and incidence rates, histologic features, but also \nspecific imaging features which must be known by radiologists. MRI screening \nprotocols must be adjusted to the specific needs of this (usually very young) \nscreening population. This presentation will review the current evidence with \nrespect to screening of women at high familial risk of breast cancer and will \nprovide information on all aspects mentioned above.  \nLearning Objectives:\n1. To understand breast cancer genetics (genes, DNA, mRNA). \n2. To understand the importance of family history, genetic disorders and \nsyndromes with increased incidence. \n3. To appreciate the role of MRI in screening and downstream management. \n14:00 - 15:30 Room F1  \nJoint Course of ESR and RSNA (Radiological Society  \nof North America): Emergency Radiology  \nMC 622  \nChest emergencies  \nModerators:  \nS.E. Mirvis; Baltimore, MD/US \nA. Palko; Szeged/HU \nA-136 14:00 \nA. Thoracic injuries  \nS.E. Mirvis; Baltimore, MD/US (smirvis@umm.edu) \nChest trauma is directly responsible for 25% of all trauma deaths and is a \nmajor contributor in another 50% of all trauma mortality. Blunt trauma, \naccounting for 90% of chest injuries, is the third most common site of injury in \npolytrauma patients. Plain radiographs still have a role in recognition of some \nacute thoracic pathology that requires immediate further management, either \ndiagnostically and/or thera peutically, such as tension pneumothorax, major \ntransdiaphragmatic herniation, large hemothorax or obvious mediastinal \nhematoma. MDCT of the chest is now typically included in a whole body scan \nwith IV contrast to facilitate rapid diagnosis on polytrauma cases using less \nradiation than selected segmental scans. MDCT is the well-proven diagnostic \ngold standard for chest injury evaluation. The major advantages of MDCT over \nother modalities include identification of active bleeding, direct signs of trachea \nor esophageal injury, direct evidence of major arterial vascular injury, such as \npseudoanurysms, pneumo and hemopericardium, location and extent of lung \ncontusion and laceration, and assessm ent for thoracic spine, shoulder girdle \nand rib fractures. Diaphragm injuries are well depicted by MDCT, especially on \nthe left by identifying both the torn diaphragm edges, herniation and \nconstriction of abdominal contents at the level of the torn diaphragm (collar \nsign), and direct contact of herniated structures with the posterior chest wall \n(dependent viscera). Tracheal injuries are suggested by diffuse and \nprogressive pneumomediastinum, dilated tracheostomy cuff, ectopic \nendotracheal tube, and direct connection of mediastinal air with the trachea \nlumen. CT-angiography eliminates the majority of indications for diagnostic \ncatheter angiography.  \nLearning Objectives:\n1. To learn how to differentiate traumatic aortic injuries from congenital variants \nthat mimic injury, to distinguish minor from major aortic injuries, and to \nunderstand how injury classification can influence management. \n2. To become familiar with the various CT appearances suggesting and \nverifying major airway injury. \n3. To understand the various CT appearances of blood/bleeding in the chest \nand how the location, quantity of blood/bleeding and patient clinical status \ndetermine initial treatment. \n4. To appreciate the spectrum of cardiac injuries that can be diagnosed on \nadmission contrast-enhanced CT and those that require urgent intervention. \n\nA B C D E F G S33  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-137 14:30 \nB. Non-traumatic thoracic emergencies  \nC.M. Schaefer-Prokop; Amersfoort/NL (cornelia.schaeferprokop@gmail.com) \nPulmonary symptoms such as chest pain, shortness of breath or wheezing are \ncommon non-traumatic symptoms prompting ER visits. Because clinical \nsymptoms are very non-specific, imaging plays a major role in differentiating \nlife-threatening from less severe diseases and forming a diagnosis. The chest \nradiograph remains the first imaging despi te its limited sensitivity for certain \ndiseases and being prone to inter-observer variability. Comprehensive \ncardiothoracic CT examinations using most modern CT equipment are well \nevaluated in their diagnostic accuracy to determine the presence of vascular \nlife-threatening events such as aortic dissection, acute coronary disease or \npulmonary embolism. Protocols and literature evidence will be discussed. The \nmain focus of the course, however, will lie on the analysis of pulmonary CT \nfindings and its contribution to the differential diagnosis of pulmonary \nemergencies (e.g. pneumonia, oedema, pneumothorax, exacerbation of fibrotic \nor obstructive lung diseases) and how to further integrate imaging findings, \nlaboratory findings, patient history and clinical information to tackle the \ndifferential diagnosis. Imaging findings will be discussed by clinical case \nstudies, key findings and also overlapping  morphological features of other \ndifferential diagnosis will be discussed side by side, illustrating the options and \nalso limitations of imaging findings.  \nLearning Objectives:\n1. To become familiar with protocols and diagnostic performance of \ncomprehensive cardiothoracic CT examinations for determining the presence \nof life-threatening vascular events such as aortic dissection, acute coronary \ndisease and pulmonary embolism. \n2. To understand typical but, also less common, CXR and CT findings in \npatients with pulmonary or mediastinal diseases causing acute dyspnoea \nand/or requiring immediate treatment, and to learn about key imaging findings \nin these patients allowing for a fast differential diagnosis. \n3. To learn how to adapt CT protocols to CXR findings and to integrate imaging \nfindings into lab findings, patient history and clinical information in order to \nmake a diagnosis. \nA-138 15:00 \nC. Interactive case discussion  \nS.E. Mirvis1, C.M. Schaefer-Prokop2; 1Baltimore, MD/US, 2Amersfoort/NL  \n14:00 - 15:30 Room N/O  \nESOR Session  \nMentoring in radiology  \nModerators:  \nG. Frija; Paris/FR \nN. Gourtsoyiannis; Athens/GR \nA-139 14:00 \nIntroduction  \nG. Frija; Paris/FR (guy.frija@egp.aphp.fr) \nMentor was first introduced in Greek mythology, and in its modern usage first \nrecorded by a French writer, François Fénelon, in 1699. Since then, this \nconcept has been widely used in the development of mentoring, mentorship \nand more recently of mentees, with an overarching principle based on \naccompanying, sowing, catalysing, showing and harvesting. This concept \nremains today as a fundamental one in all teaching activities and implies \ngenerally a close contact between the mentor and the mentee. However, the \ndevelopment of Internet with concomitant e-learning capabilities, which are \nhugely increasing, raises the very challenging necessity to re-think this concept \nand to adapt it to this new era. The ESR is very concerned by this endeavour \nin the context of the striking development of ESOR, on one hand, and with the \nlaunching of its e-library, on the other.  \nA-140 14:05 \nESOR in action 2014  \nN. Gourtsoyiannis; Athens/GR (gournick@gmail.com) \nThe presentation \"ESOR in action\" gives an overview on all ESOR activities in \n2013 and 2014. A detailed report on the ESOR courses and teaching \nprogrammes in 2013 is presented, containing statistics about the number of \ncourse participants and of scholarship and fellowship grants. Additionally, all \neducational activities in 2014, including dates, venues, topics and local \norganisers, are announced.  \nA-141 14:20 \nEvidence-based radiology: the basics  \nF. Sardanelli; Milan/IT (f.sardanelli@grupposandonato.it) \nEvidence-based medicine (EBM) was derived from clinical epidemiology during \nthe last century. It \"is the conscientious, explicit, and judicious use of current \nbest evidence in making decision about the care of individual patients\" (Dave \nL. Sackett, 1996). This means integrating (1) individual clinical expertise with \n(2) the best available external evidence from systematic research and (3) \npatient's values and preferences. When considering evidence-based radiology \n(EBR), the needed expertise is not only clinical, but also technical, while (4) \nradioprotection issues assume a relevant value according to the \"as low as \nreasonably achievable\" (ALARA) principle. EBM (and EBR) can be practised \naccording to the \"top-down\" model, when using guidelines issued by \ngovernmental, professional, or academic bodies, or the \"bottom-up\" model, \nwhen local physicians (1) formulate an answerable question, (2) search for the \nbest evidence; (3) appraise critically; (4) apply findings to practice; and (5) \nevaluate the performance. A hierarchy of radiological studies has been \nestablished according to the investigated matter: 1. technical performance; 2. \ndiagnostic performance; 3. diagnostic impact; 4. therapeutic impact; 5. patient \noutcome; 6. societal impact. Different degrees of recommendations are based \non different levels of evidence, with experts' opinion as the lowest level and \nmeta-analyses of high-quality homogeneous studies and multicenter studies \nbeing the best level of evidence. To practise EBR, radiologists should be \nfamiliar at least with basic statistics and epidemiology as well as of methods for \nstudy design, thus recognising the principal types of bias which can limit the \nvalue of published studies.  \nLearning Objectives:\n1. To understand the historical development and general principles of \nevidence-based medicine (EBM) with its top-down and bottom-up approaches. \n2. To learn how to apply EBM principles to radiology (evidence-based \nradiology, EBR) and to illustrate the main reasons for the relative delay in \ndeveloping EBR, including the challenges of fast technological innovation in \nmedical imaging. \n3. To learn about the relationship between levels of evidence and the strength \nof recommendations for diagnostic imaging and interventional radiology. \n4. To learn how radiologists could play a stronger role in building the evidence \nin favour of diagnostic imaging and interven tional radiology, taking the patient's \ninterest as the primary aim of clinical practice and science. \nA-142 14:35 \nEducation in research: action plan  \nJ. Hodler; Zurich/CH \nA survey regarding education in research has been commissioned by the ESR \nand published in Insights Imaging (2012) 3: 535-542. The results indicate that \neducation in research, associated with career models, needs promotion. The \nResearch Committee of the ESR is working on possible future steps to \npromote research through education. Several problems will have to be \naddressed, most notably inhomogeneity within Europe, motivation issues, ill-\ndefined career paths as well as funding issues. Several stakeholders will play \nan important role, including scientific societies, although this is the core \nbusiness of academic radiology chairmen.  \nLearning Objectives:\n1. To become familiar with the current status of research education in \nradiology. \n2. To understand the importance of research education for the long term \ndevelopment of radiology. \n3. To learn about possible actions for promotion of education in research. \nAuthor Disclosure:\n J. Hodler: Equipment Support Recipient; Siemens, General Electric. Grant \nRecipient; Guerbet, Bayer. \nA-143 14:50 \nMentoring in radiology  \nH.-U. Kauczor; Heidelberg/DE (Hans-Ulrich.Kauczor@med.uni-heidelberg.de) \nMost young professionals starting a career in academic institutions are eager \nto expand their professional and per sonal aptitudes. An effective way to \nsupport young professionals in this regard is by mentoring. Mentorship is a \nrelationship where the mentor supports a junior faculty member (mentee) in \npersonal and professional development. The mentee benefits from early \ndetermination and initiation of career-relevant steps, greater productivity in \nresearch and publishing activity and developing techniques in networking and \ncollaboration. Moreover, the mentee gains perspectives on how his/her \ndiscipline operates academic ally, socially and politically, improves self-efficacy \nand deals more confidently with challenging intellectual work. The mentor, a \nknowledgeable, experienced and regarded person, benefits from fresh ideas, \nenergy and curiosity of mentees, as well as through acceptance as a mentor \nan enhanced status in the department. It is a trusted relationship of dialogue, \n\nA B C D E F G S34  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nlearning and challenges, based on mutual interests. However, the mentor is \nnot automatically the best friend or the sole exclusive advisor of the mentee. \nMore and more academic medical institutions offer facilitated mentoring \nprogrammes, which help the mentoring pairs to create an effective mentoring \nrelationship to accomplish the desired skills. Evaluation of faculty mentoring \nprogrammes in academic medical institutions demonstrates the importance of \nmentoring in research and academic development as well as in patient care. \nEspecially in radiology where over many years there have been challenges in \nrecruiting and retaining talented young professionals, mentoring is considered \nas an essential way for preparing the next generation of scientific and \nintellectual leaders.  \nLearning Objectives:\n1. To learn the definition, types and benefits of mentoring. \n2. To become familiar with the roles and tasks of mentor and mentee. \n3. To understand the importance of mentoring for career development. \n4. To appreciate potential reservations and gender issues in mentoring. \nAuthor Disclosure:\n H.-U. Kauczor: Equipment Support Recipient; Siemens, Philips. Speaker; \nBracco, Siemens, Boehringer, Bayer, Novartis. \nAwards  \n15:05\n16:00 - 17:30 Room A  \nInteractive Teaching Session  \nE³ 720a  \nPitfalls in head and neck imaging  \nA-144 16:00 \nA. Pitfalls in neck imaging  \nF.A. Pameijer; Utrecht/NL (f.a.pameijer@umcutrecht.nl) \nPitfall: \"a hidden or unexpected danger or difficulty\". Imaging methods can \nprovide an extraordinary amount of useful data to specialists treating head and \nneck (cancer) patients. It is crucial that these data are used to full advantage of \nindividual patients. The most important factor in this process is mutual \ncooperation between the physicians in charge of patient care and the \ndiagnostic imaging specialist. Pitfalls in the head and neck may present in \nvarious ways: normal variants may look  like disease, incidental findings are \nfrequently encountered and suboptimal technique may obscure important \nfindings. Moreover, many pitfalls are directly related to technical errors. The \npresentation aims to familiarise general radiologists, who have an interest in \nhead and neck imaging, with common pitfalls encountered on CT and MR \nstudies focussing on the neck. In an interactive setting, examples from daily \npractice will be discussed.  \nLearning Objectives:\n1. To understand the variations of normal anatomy in the neck that should not \nbe interpreted as abnormal. \n2. To become familiar with the incidental findings which are frequently \nencountered when searching for neck disease. \n3. To learn about suboptimal neck studies, or technique related problems, and \nunderstand how these may influence interpretation. \nA-145 16:45 \nB. Pitfalls in maxillofacial and skull-base imaging  \nR. Hermans; Leuven/BE (Robert.Hermans@uzleuven.be) \nImaging of the skull base and maxillofacial skeleton requires a meticulous \nimaging technique and a good knowledge of normal anatomy and possible \nanatomical variants. Asymmetry in the pneumatisation of the paranasal \nsinuses, skull base or temporal bone is a common reason for misinterpretation. \nFor example, hypoplasia of the maxillary sinus may be misinterpreted on \nconventional radiography as maxillary sinusitis or orbital blowout fracture, \ndepending on the context; asymmetric pneumatisation of the petrous apex or \nmastoid bone may mimic, respectively, a cholesterol granuloma and fluid \neffusion in the non-pneumatised side on MRI. Vascular variants may also \ncause interpretation problems. For example, turbulent flow in a large jugular \nbulb may mimic a jugular foramen tumour on MRI. Variants in the vascular \nplexus surrounding the trigeminal or facial nerve may occur, and cause \nasymmetric findings on MRI, possibly mimicking neuritis or perineural tumour \nspread. Incomplete maturation or arrested development of skull base \nstructures may also cause confusion. Examples are the cochlear cleft, not to \nbe confused with otosclerosis, or arrested pneumatisation of the sphenoid \nsinus, possibly mimicking a tumoural lesion in the central skull base. To avoid \nproblems, one should keep in mind the existence of such variants, while \ncorrelating the imaging findings with the clinical problem; in some cases, an \nadditional imaging study may be needed to exclude a pathological process \nmore confidently.  \nLearning Objectives:\n1. To understand the basic requirements for an optimal imaging study of the \nskull base and maxillofacial region. \n2. To become familiar with anatomical variants potentially mimicking disease. \n3. To learn to appreciate incidental findings, thus avoiding unnecessary \nconcern while recognising relevant pathology. \n16:00 - 17:30 Room B  \nState of the Art Symposium  \nSA 7  \nCardiac computed tomography: from \ndiagnosis to prognosis  \nA-146 16:00 \nChairman's introduction  \nM. Dewey; Berlin/DE (dewey@charite.de) \nThis short 5-min introduction by the session chairman will give an overview of \nthe current state of cardiac computed tomography (CT) for diagnosis and \nprognosis. In addition, the introduction will provide the basis for the subsequent \ndedicated lectures covering low radiation dose, diagnostic accuracy, and \nincidental findings in cardiac CT.  \nSession Objectives: \n1. To become familiar with the potential of cardiac CT to diagnose coronary \nartery disease. \n2. To understand current research projects about on non-invasive diagnosis of \ncoronary artery disease. \n3. To learn about the facilitation of clinical management decisions in patients \nwith suspected or known disease. \nAuthor Disclosure:\n M. Dewey: Author; editor of Coronary CT Angiography and Cardiac CT, both \npublished by Springer. Consultant; Guerbet. Equipment Support Recipient; \nInstitutional master research agreements exist with Siemens Medical Solutions, \nPhilips Medical Systems, and Toshiba Medical Systems. The terms of these \narrangements are managed by the legal department. Grant Recipient; \nHeisenberg Program of the DFG. European Regional Development Fund. \nGerman Heart Foundation. German Federal Ministry of Education and \nResearch. GE Healthcare, Bracco, Guerbet, and Toshiba. Speaker; Toshiba \nMedical Systems, Guerbet, Cardiac MR Academy Berlin, and Bayer (Schering-\nBerlex). \nA-147 16:05 \nWhat are the protocols with the lowest radiation dose in clinical practice?  \nJ.-F. Paul; Le Plessis Robinson/FR (pauljf@ccml.fr) \nThe radiation dose delivered for coronary CT angiography using retrospective \ngating is high, because only a small part of the total radiation delivered is used \nfor the reconstruction of the image in the retrospective mode. On average, 20% \nof the radiation burden is used to reconstruct one phase of the cardiac cycle. \nECG-triggered tube current modulation allows reducing the nominal dose by up \nto 96% in the systolic phase. Another approach for reducing radiation exposure \nis to use prospective, sequential acquisition, with this approach being \nassociated with 75% dose reduction compared to the spiral retrospective \nacquisition. Exposure time may be also  shortened by an increase of pitch, in \nparticular on the dual-source CT. However, applicability to each dose-sparing \ntechnique depends on the heart rate and its regularity. Dose-sparing strategies \nshould be modified in case of high or irregular heart rate and radiation dose \nreduction may be less effective. For coronary CT angiography, individually \nweight-adapted protocols have been successfully applied, by adjusting mAs to \npatient's weight. More recently, settings of 100 kV and even 80 kV have been \nsuccessfully used for cardiac studies, especially in slim patients or children. \nReduction of exposure time and individual  adaptation have an additive effect \non dose reduction: it has thus been possible to scan down under 1 mSv in \nselected, slim patients, using this combined approach. In many cases, using \nthe latest technology, radiation dose may be lower than the mean radiation \ndose associated with conventional angiography.  \nLearning Objectives:\n1. To understand various protocols to lower radiation dose in cardiac CT with \nregard to the clinical situation and the risk of image quality impairment. \n2. To learn how to tailor the radiation dose level to each patient in terms of \nmorphology. \n3. To become familiar with modulating exposure windows in regards to a \npatient's ECG. \n\nA B C D E F G S35  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-148 16:28 \nHow accurate and prognostically valid is coronary CT angiography?  \nF. Cademartiri, E. Maffei; Monastier di Treviso/IT\n(filippocademartiri@gmail.com) \nThe role of cardiac computed tomography in cardiovascular diseases is \nbecoming increasingly important. CCT is a robust and reliable investigation for \nthe detection and exclusion of significant coronary artery disease. In addition, \nCCT provides reliable noninvasive information concerning coronary plaque \nburden (severity, distribution, type), morphology and function of left and right \nventricle, valves, aorta, and so forth. In  the past 5 years, the prognostic role of \nCCT has been established. The prognostic information that can be \nextrapolated from CCT is very diverse and most of it is still under investigation. \nThere are converging evidences that CCT can stratify cardiovascular risk better \nthan conventional clinical methods, especially in symptomatic patients. For \nasymptomatic individuals, the role is still controversial since coronary calcium \nscore alone has a very important role already. Several aspects of CCT \ninformation seem to have importance for prognostic stratification: plaque \npresence, obstruction, plaque type and distribution. More recent studies have \nstarted showing the relationship between CCT and pharmacological treatment. \nThis is a very new and appealing topic, since the evidence is towards the fact \nthat the most effective pharmacological treatment (e.g. statin) should be \nrestricted to patients with at least some nonobstructive CAD as detected by \nCCT. This might become a revolutionary  concept in cardiovascular medicine \nwith several implications.  \nLearning Objectives:\n1. To learn about and integrate the prognostic information from coronary CT \nangiography into conventional methods. \n2. To learn about coronary CT angiography and conventional methods. \n3. To appreciate the prognostic impact of coronary CT angiography and \nconventional methods. \nA-149 16:51 \nIncidental findings in cardiac CT: how to report and proceed  \nS. Leschka; St. Gallen/CH (sebastian.leschka@kssg.ch) \nRapid advances in computed tomographic (CT) technology have facilitated the \nwidespread use of CT for cardiac imaging worldwide, and can be considered \nnowadays an essential part of the clin ical workup of patients with suspected \ncoronary artery disease. Albeit that the performed CT study is focussed on the \ncardiac structures and the coronary arteries, adjacent noncardiac structures \nare in the field of view whenever a pati ent undergoes cardiac CT to quantify \ncoronary calcium or to perform a noninvasive coronary angiogram. In addition, \nthe location of the heart near other anatomic regions, including the lungs, \nmediastinum, upper abdomen, and bones, necessitate that these structures \nare included when acquiring coronary CT angiographic images. Several \npublications have demonstrated a high frequency of incidental findings on \ncoronary CT angiography. The availability of this information is part of an \nongoing clinical debate. While some radiologists believe that every image \nshould be interpreted completely, others believe that examining noncardiac \nstructures reveal too many incidental findi ngs of uncertain clinical significance, \nwhich may harm because additional testing increases risk, cost, and patient \nanxiety. The aim of this lecture is to separate solid facts from opinions and \nbeliefs.  \nLearning Objectives:\n1. To understand the pros and cons of reporting extracardiac findings at \ncardiac CT. \n2. To understand the clinical consequences of incidental findings. \n3. To learn when additional testing is reasonable and when it's not. \nAuthor Disclosure:\n S. Leschka: Speaker; Siemens Healthcare, Guerbet, GE Healthcare. \nPanel discussion:  \nCardiac CT: ready to go clinical?  \n17:14\n16:00 - 17:30 Room C  \nControversies in Chest Imaging  \nMC 724  \nDiagnosis of pulmonary embolism when \nCTA is indeterminate or unfeasible  \nModerator:  \nA. Perrier; Geneva/CH \nTeaser:  \nM. Rémy-Jardin; Lille/FR \nA-150 16:00 \nA. Radiological approach: ultrasound and MR imaging  \nM.-P. Revel; Paris/FR (marie-pierre.revel@htd.aphp.fr) \nMR imaging and ultrasound may be used as alternative techniques for \npulmonary embolism (PE) diagnosis, when CT angiography is indeterminate or \nnot feasible, which occurs in up to 22% of the cases. Deep venous thrombosis \n(DVT) and pulmonary embolism are two clinical presentations of the same \ndisease. Finding a proximal DVT in patients suspected of PE is sufficient to \nwarrant anticoagulant treatment without further testing. The only validated \ndiagnostic criterion for DVT is incomplete compressibility of the vein on \ncompression ultrasound (CUS). A positive CUS of the proximal lower limb \nveins is highly predictive of PE on computed tomography in suspected \npatients. A large prospective outcome study reported 39% sensitivity of CUS \nfor the presence of PE on MSCT and 99% speci ficity. Including the distal veins \nincreases CUS sensitivity, but decr eases specificity to only 84%. The \nprobability of a positive proximal CUS in suspected PE is higher in patients \nwith leg symptoms. MRI diagnosis of PE is mainly based on MR angiography \n(MRA) sequences. Unenhanced sequences using steady-state-free precession \nare now available, in addition to traditional gadolinium-enhanced MRA. There \nare conflicting results regarding the di agnostic value of perfusion sequences, \nwith reported sensitivity reaching 100% in some series, whereas others report \nonly 75-79% sensitivity. MR shows very high specificity for the diagnosis of PE, \nreaching 99%, but still limited sensitivity, except for proximal PE diagnosis. Its \nmain limitation is the high proportion of technically inadequate or inconclusive \nimages, ranging from 25 to 30%, but ongoing developments should overcome \nthis current limitation.  \nLearning Objectives:\n1. To understand the role of ultrasound in the diagnostic strategy for pulmonary \nembolism. \n2. To learn about the technical aspects of MR imaging in the diagnosis of \npulmonary embolism. \n3. To appreciate the performance and limitations of MRI in the diagnosis of \npulmonary embolism. \nA-151 16:25 \nB. Nuclear medicine approach: combined ventilation-perfusion SPECT \nand low-dose CT  \nH. Gutte; Copenhagen/DK (henrikgb@gmail.com) \nThe diagnosis of pulmonary embolism ( PE) is usually established by a \ncombination of clinical asses sment, D-dimer testing, and imaging with either \npulmonary ventilation-perfusion (V/Q) scintigraphy or pulmonary multidetector \nCT angiography (CTPA). V/Q scintigraphy is a functional imaging method \nusing isotopes for the visualisation of venti lation and perfusion distribution in \nthe lungs. In recent years, the imaging techniques for diagnosing PE have \nimproved. Many nuclear medicine centres have adopted the single photon \nemission computed tomography (SPECT) technique as opposed to the planar \ntechnique when diagnosing PE. The introduction of 3-dimensional V/Q SPECT\ntechnology instead of 2-dimensional planar V/Q scintigraphy has resulted in \nfewer indeterminate results and a higher diagnostic value. The latest \nimprovement is the addition and combination of a low-dose CT without contrast \nto the V/P SPECT (SPECT/CT) technique. The SPECT/CT in combination has \nbeen compared to CTPA, planar scintigraphy and SPECT alone, and one \nstudy has shown that SPECT/CT in combination had the highest diagnostic \naccuracy for PE diagnosis. SPECT in combination with low-dose CT without \ncontrast enhancement is superior, especially for small subsegmental emboli; \nhowever, consensus is lacking regarding the clinical impact and treatment. \nSPECT and SPECT/CT may provide alternative diagnosis if PE is refuted and \nare feasible in almost all patients, because there are no definitive \ncontraindications. In the present lecture, SPECT and SPECT in combination \nwith low-dose CT are discussed in the context of diagnosing PE.  \nLearning Objectives:\n1. To understand the principle of hybrid gamma-camera/MDCT system. \n2. To appreciate the diagnostic performance and limitations of SPECT-CT for \nthe diagnosis of pulmonary embolism. \n\nA B C D E F G S36  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-152 16:50 \nDiscussion  \nA. Perrier1, M. Rémy-Jardin2; 1Geneva/CH, 2Lille/FR \nThe discussion will address the following issues: \nThe choice of imaging modality in cases of indeterminate or unfeasible CTA \ndepends on: patient age, pregnancy, presence or absence of clinical \nsymptoms suggesting limb venous thrombosis, acute or chronic clinical \nsituation, imaging technique availability, level of clinical probability of \nthromboembolic disease \n16:00 - 17:30 Room D  \nEmergency Radiology  \nRC 717  \nER: basic principles - polytrauma: feel \nyour own pulse first!  \nModerator:  \nD.R. Kool; Nijmegen/NL \nA-153 16:00 \nA. Logistics and management  \nM. Körner; Landshut/DE (markus@dr-koerner.net) \nOver the last few years, emergency radiology (ER) has been a subspeciality \nwith growing interest. Because of rapid developments in technology, CT has \nbecome the most useful tool in evaluating trauma and other emergency \npatients. In this lecture, the basics of planning and organising an ER \ndepartment are presented and discussed. Besides optimising technical \nequipment and protocols for imaging, different logistic concepts have to be \nconsidered in planning and organising ER departments. First of all, logistic \nconcepts have to be considered for obtaining an optimal workflow: the \nradiology department has to be in close proximity to the emergency \ndepartment and the admitting area, in particular. The whole workflow must be \noptimised for speed and accuracy. This also mandates having dedicated and \nstandardised examination and viewing protocols for CT. In contrast to the USA \nwhere dedicated emergency radiology departments are well established, non-\nspecialised radiologists still frequently do the reading of emergency radiology \ncases in European countries. The radiologic staff involved has to be trained for \ninterpretation of trauma and other emergent cases. This does not only account \nfor residents, but also for consultants and attending radiologists. Since a large \nnumber of cases will arrive during after hours and on weekends, staffing has to \nbe adjusted to this fact, which includes attending radiologists to be available \nduring these hours on call or, preferably, on-site. This lecture will give an \noverview of logistic concepts and org anisation of an emergency department \nand will also discuss critical issues in polytrauma imaging.  \nLearning Objectives:\n1. To understand how an emergency radiology department should be \norganised. \n2. To become familiar with the logistics, staffing and technical equipment of an \nER department operating 24/7. \nA-154 16:30 \nB. Polytrauma: choosing the right protocol  \nS. Wirth, M. Muggenthaler, L. Geyer, K. Weber, F. Mück, M.F. Reiser; \nMunich/DE (swirth@med.uni-muenchen.de) \nAt least during the radiological training in hospitals, every radiologist will \npersonally be confronted with the treatment of polytraumatised patients. It is a \nfact that standardised whole body MDCT (WB-CT) as an independent predictor \nis able to save around 20% of patient lives. Thus, WB-CT is the major \ndiagnostic tool and should be performed as fast as possible. Some institutions \nbypass the emergency room and directly start patient stabilisation in the CT \ncabinet. However, radiographs and focused ultrasound remain important in \ngeneral settings as long as they are performed in a way which does not delay \nCT diagnostics. After scanning, specially trained radiologists support the whole \ninterdisciplinary team with correct, appropriate and prioritised diagnoses. \nBesides optimisation of parameters like l ogistics, patient positioning preferably \n'feet first', reading and communication, 'cho osing the right protocol' is a crucial \nfactor for ideal radiological patient care. Four types of protocols should be \ndifferentiated: 1. Polytrauma 1 - WB-CT with scanning the upper abdomen \ntwice, one time in arterial and one time in portal venous phase; 2. Polytrauma 2 \n- WB-CT without scanning the upper abdomen twice, but instead utilising a \ndouble bolus protocol for mixed phase contrast enhancement; 3. WB-CT under \nresuscitation; 4. WB-CT as triage tool in the case of mass casuality incidents \n(MCI, up to 20 patients per hour).  \nLearning Objectives:\n1. To understand the relationship between emergent imaging and emergency \nradiology. \n2. To learn more about the rational use of CR, US and CT according to patient \npriorities in the emergency setting. \n3. To become familiar with established whole-body MDCT protocols and their \nrelation to injuries. \nA-155 17:00 \nC. Whole-body CT: dose reduction and data handling  \nM. Rieger; Hall i. Tirol/AT (michael.rieger@tilak.at) \nThere is a wide agreement that for patients with polytrauma, integrating whole \nbody computed tomography (CT) scan into early trauma care significantly \nincreases the probability of survival. Therefore, CT is today considered the \nmost important imaging technique in the diagnostic workup of polytrauma \npatients. The downside of whole body CT represents the relatively high \nradiation exposure. To overcome this handicap, the following measures can be \ntaken: 1. positioning of the arms during whole body CT above the head results \nin reduction of radiation dose; 2. adaption of scan parameters, especially \nreduction of tube voltage to 100 kV reduces radiation dose; 3. installation of \nrecent technical improvements like iterative reconstruction algorithm reduces \nnoise in the image, allowing a downward adjustment in radiation dose to obtain \nstandard diagnostic quality images; 4. installation of dose control software \nenables optimisation and improved dose management over time. Another \ndisadvantage of high-resolution whole body CT is the amount of acquired data. \nTo optimise the workflow in the eva luation of a couple of thousand sub-\nmillimetre images it is necessary to connect the MDCT scanner with a \ndedicated workstation for volume image reading, which offers the possibility of \nquick multiplanar online evaluation.  \nLearning Objectives:\n1. To understand new concepts of CT dose reduction. \n2. To become familiar with the correlation of large data sets and the need for \nrapid data acquisition in the emergency radiology setting. \n16:00 - 17:30 Board Room B  \nNew Horizons Session  \nNH 7  \nThe human connectome: a comprehensive \nmap of brain connections  \nA-156 16:00 \nChairman's introduction: definitions and basic imaging technique  \nP. Hagmann; Lausanne/CH (patric.hagmann@epfl.ch) \nIn this introduction I will define the connectome (a comprehensive map of \nneural connections in the brain) and related concepts such as scaling, \nstructural and functional connectivity as well as the integration-segregation \nparadigm. The development of MRI-based techniques such as white matter \ntractography and segmentation of white and gray matter has played a crucial \nrole in the emergence of connectomics by providing tools to map in vivo the \nentire human structural connectivity at a macroscopic scale. I will explain these \nmethods and how from MR imaging a human connectome can be mapped and \nrepresented as a network (set of nodes and edges). Finally, I will also review \nthe validation work related to those techniques and mention the foreseen \ntechnical advancements in the field.  \nSession Objectives: \n1. To learn what the human connectome is and how it is affected by brain \ndisease. \n2. To understand how the human connectome can be imaged and \ncharacterised with MRI. \n3. To become familiar with the network formalism and its interpretation. \n4. To understand the relationship between brain function and underlying \nstructural connectivity. \n5. To understand the conceptual ideas behind connectomics. \n6. To learn about the general workflow, from diffusion imaging to mapping a \nstructural brain network. \n7. To become familiar with the robustness of the technique by reviewing \nvalidation studies and getting a glimpse of the technical challenges. \n\nA B C D E F G S37  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-157 16:15 \nThe economics of brain networks  \nE. Bullmore; Cambridge/UK (etb23@cam.ac.uk) \nWe review the methods and recent results of network analysis of human \nneuroimaging data. Human functional MRI and structural MRI data can be \nanalysed using mathematical tools drawn from graph theory to quantify the \ncomplex (non-random) topological proper ties of brain networks. These results \ncan be substantiated by meta-analysis of prior neuroimaging results and \nanalysis of non-human nervous systems. Brain networks consistently express \ncomplex topological features, such as small-worldness, hubs, modules and rich \nclubs. Some of these features entail disproportionate biological cost, but may \nbe \"worth it\" by supporting integrative information processing and adaptive \nbehaviours. Highly connected hub nodes are high cost/high value network \ncomponents that likely also represent special points of vulnerability for diverse \nbrain disorders. These economical principl es of brain network organisation are \nexpressed at the microscopic scale, e.g., in the nervous system of the \nnematode worm C. elegans , and may therefore provide a new axis for \ntranslation between macro and micro systems neuroscience. Neuroimaging \ncan be used to elucidate the economical principles of human brain network \norganisation in health and disease.  \nLearning Objectives:\n1. To understand network metrics through examples of different network types \nand their characteristics. \n2. To appreciate the organisation of the human connectome in health and \ndisease. \n3. To become familiar with the relation between network organisation and \ncognition. \nAuthor Disclosure:\n E. Bullmore: Employee; GlaxoSmithKline. Shareholder; GlaxoSmithKline. \nA-158 16:35 \nConnectomics in brain pathology  \nM.P. van den Heuvel; Utrecht/NL (m.p.vandenheuvel@umcutrecht.nl) \nHealthy brain function depends on effici ent functional communication within a \ncomplex network of structural neural connections, a network known as the \nconnectome. Conversely, damage to the brain's network, disrupting local \nneuronal processes and/or global co mmunication between remote functional \nsystems may lead to brain dysfunction. In the last few years, emerging \nevidence from a wide variety of studies suggests that connectome \nabnormalities may indeed play an important role in the aetiology of several \nbrain disorders. In my talk, I will discuss the results of recent studies \nsuggesting an important role for affected connectome organisation in a number \nof neurological and psychiatric disorders. In particular, I will highlight the \nfindings of affected functional and structural brain network in \nneurodegenerative disorders such as Alzheimer's and ALS, as well as discuss \nhow the application of network science and connectomics may aid our \nunderstanding of the biological basis of psychiatric disorders such as autism \nand schizophrenia.  \nLearning Objectives:\n1. To understand the role of connectome architecture in (cognitive) brain \nfunction and dysfunction using diffusion MRI/functional MRI. \n2. To become familiar with connectomics as a tool for examining disease \npathology in a wide range of neurological and psychiatric brain disorders. \nA-159 16:55 \nLinking structure and function: the role of modeling in understanding the \npathophysiology  \nG. Deco; Barcelona/ES (gustavo.deco@upf.edu) \nThe interplay of the brain's intrinsic activity and the external world has seen a \nrevival in the last decade, especially in neuroimaging. A long-held assumption \nin many of these studies has been that ongoing brain activity is sufficiently \nrandom that it averages out in statistical analysis. Hence, imaging studies are \ntermed 'activation' paradigms, where experimental manipulation results in the \nactivation of cerebral circuits that are necessary for performing the task. \nNevertheless, a large amount of recent literature reports a body of \nobservations that there are consistently distributed patterns of activity during \nrest. This fact has led to the suggestion that it might be possible to characterise \nnetwork dynamics without needing an explicit task to drive brain activity. \nIndeed, numerous neuroimaging experiments have evidenced the solid \nexistence of spontaneous long-range correlat ions, i.e. functional connectivity \n(FC), by fMRI, MEG, and EEG techniques. The functional connectivity is \ndefined as the statistical dependence between remote neurophysiological \ndynamics. The emergence of resting functi onal connectivity is intrinsically \nlinked with the underlying anatomical connections between those areas, i.e. \nthe structural connectivity. W hole brain modeling can indeed establish a direct \nlink between structure and function. Furthermore, the modeling can shed light \non the origin of pathological functional disfunction by making the link with the \nunderlying anatomy explicit. We will show how, structural DTI tractography, \nfunctional imaging and modelling studies can be combined for reaching this \ngoal.  \nLearning Objectives:\n1. To understand large-scale models of the whole brain. \n2. To learn about the mechanisms underlying resting and task activity. \n3. To become familiar with the fusion of structural (diffusion MRI) and functional \n(functional MRI/MEG) data. \nPanel discussion:  \nWhat will connectomics bring to clinicans in the future?  \n17:15\n16:00 - 17:30 Room E1  \nMusculoskeletal  \nRC 710  \nTrauma to the paediatric skeleton  \nModerator:  \nM. Padrón; Madrid/ES \nA-160 16:00 \nA. Pelvis/hips  \nN. Boutry, B. Herbaux; Lille/FR (nboutry@gmail.com) \nTraumas to the paediatric pelvis and hip include traumatic dislocations of the \nhip, fractures of the femoral neck, fractures of the pelvic ring, acetabular \nfractures and apophyseal avulsion fractures. Traumatic dislocations of the hip, \nfractures of the femoral neck, fractures of the pelvic ring and acetabular \nfractures are rare in children (less than 5% of paediatric fractures), as \ncompared to adults. These fractures are commonly the result of high-energy \ntrauma. Imaging is based on plain radiographs, but CT and MRI are very useful \nto precisely assess bone (CT) and cartilage and soft tissue (MRI) lesions. \nImaging enables accurate diagnosis, appropriate treatment and detection of \npotential complications (femoral head osteonecrosis, premature physeal \nclosure … ). In contrast with the previous injuries, apophyseal avulsion \nfractures of the hip and pelvis are common in children and adolescents, usually \nassociated with athletic activities. In most cases, these fractures are of good \nprognosis and can be treated conservatively when minimally displaced. Plain \nradiographs confirm avulsion injuries to ossified apophyses, but MRI and \nultrasound are the modalities of choice to demonstrate injuries to nonossified \napophyses and to assess apophyseal displacement.  \nLearning Objectives:\n1. To become familiar with the types of injuries seen in the paediatric \npelvis/hips. \n2. To understand the strengths and weaknesses of different imaging \nmodalities. \nA-161 16:30 \nB. Elbow  \nK.J. Johnson; Birmingham/UK (karl.johnson@bch.nhs.uk) \nThe elbow is a very common site for fractures in a child. The challenge for the \nradiologist is to differentiate normal va riants of growth from possible injury and \nthis is usually achieved by having good-quality radiographs and an \nunderstanding of normal growth. It is important to recognise those fractures \nwhich require surgical intra-operative treatment. In a small number of cases \nwhen assessing for vascular integrity, intra-articular extent and injury to \ncartilaginous structures, ultrasound and MR imaging have a valuable role. This \nlecture will give an overview of the radiographic appearance of fractures, \nhighlight the features which require orthopaedic intervention and illustrate the \nuse of additional imaging modalities.  \nLearning Objectives:\n1. To become familiar with the types of injuries seen in the paediatric elbow. \n2. To understand the strengths and weaknesses of different imaging \nmodalities. \nA-162 17:00 \nC. Spine  \nL.B.O. Jans; Ghent/BE (lennartjans@hotmail.com) \nThe diagnosis of C-spine injury is more complex in children than in adults. \nEarly diagnosis is crucial since delayed di agnosis results in high morbidity and \nmortality. Leading mechanisms of pediatric C-spine trauma are motor vehicle \naccidents, sports and pedestrian injuries. Due to their anatomy, children are \nprone to different types and locations of injuries. Children < 10 yeas of age are \nmore likely to injure the spinal cord itself and are prone to dislocations and high \n(C1-C4) bony injuries. Children > 10 years of age more often sustain C-spine \nfractures. In children under the age of 2 years, radiographs are rarely helpful. \n\nA B C D E F G S38  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nAP and lateral radiographs are helpful in children aged between 2 and 8 years. \nIn children aged > 8 years, additional lateral and odontoid views are obtained. \nAnatomical variants such as pseudosubluxation of C2-C3, widening of the \natlantodental interval and ossification centres may appear to be of concern on \nimaging, but are normal. Abnormal radiographic findings require additional \nimaging to differentiate them further with CT on the area of concern. MRI is \nmandatory if signs of atlantorotary subluxation and spinal cord injury without \nradiologic abnormality (SCIWORA) are present. MRI identifies injuries to the \nspinal cord that are not apparent with other modalities, and should be used \nwhen a child presents with a neurologic deficit but normal radiographs on CT \nscan.  \nLearning Objectives:\n1. To become familiar with the types of injuries seen in the paediatric spine. \n2. To understand the strengths and weaknesses of different imaging \nmodalities. \n16:00 - 17:30 Room E2  \nFoundation Course: Breast Imaging  \nE³ 720b  \nImage-guided breast biopsy  \nModerator:  \nG. Esen; Istanbul/TR \nA-163 16:00 \nA. US-guided biopsy of breast and axilla  \nL.J. Pina Insausti; Pamplona/ES (ljpina@unav.es) \nNowadays, ultrasound (US) has become the first choice for performing most \nbreast biopsies. The main advantages of this technique are non-ionising \nradiation, full control of the needle position in real time and widespread use of \nUS equipments at all centres. US allows access to difficult places (such as the \naxilla or near the nipple), multiple lesions can be safely biopsied in one single \nsession, the breast is not compressed, there is excellent comfort for patients \nand radiologists, local anaesthesia and haematoma do not hide the lesion and \nit is a cost-effective technique. However, the main limitation is that the lesion \nmust be visible on US. US-guided fine-needle cytology was widely used in the \npast, but today its use has decreased. US-guided core-needle biopsy has \nproven to be a reliable technique to perform a biopsy for breast lesions, \nshowing a sensitivity value of about 98%. Furthermore, it can be safely used \nfor performing biopsies of axillary lymph nodes. Vacuum-assisted devices can \nbe used not only for diagnostic purposes, but also for therapeutic ones, \nbecause small palpable benign lesions (such as fibroadenomas), papillomas \nand radial scars can be completely removed.  \nLearning Objectives:\n1. To learn how to do it. \n2. To become familiar with the possible complications. \n3. To consolidate knowledge on the value of axillary FNA vs. core biopsy. \nA-164 16:30 \nB. Stereotactic vacuum-assisted biopsy  \nR.M. Mann; Nijmegen/NL (r.mann@rad.umcn.nl) \nStereotactic breast biopsy is the performance of tissue sampling under \nmammographic guidance. As with any imaging technique, some lesions are \nonly seen with mammography. When these lesions are suspicious (e.g. \nBIRADS 3 or higher), there are no imaging techniques that can downgrade this \nsuspiciousness directly, although for BIRADS 3 lesions follow-up might be a \nviable alternative. In mammography, most lesions that are only visible on the \nmammogram consist of clusters of microcalcifications. These harbour a \nlikelihood of around 25% being malignant and should thus be classified as \nBIRADS 4. This implies that tissue sampling is mandatory. Different from \nultrasound-guided biopsy, it is not possible to perform a real-time biopsy under \nmammographic guidance. Rather, stereotactic biopsy uses triangulation to \nassess the depth of a lesion within the breast, while the lesion location in the x- \nand y-plane is assessed on a scout view. The needle is positioned using the \ncoordinates thus obtained. Since there is no real-time feedback of the accuracy \nof needle positioning, it is necessary to  obtain substantially more tissue than \nunder ultrasound guidance. Therefore, vacuum-assisted systems are essential. \nIn case of calcified lesions, the biopsy result is controlled by x-ray. \nCalcifications should be present in the sample. Biopsy complications that occur \nunder stereotactic guidance are usually limited. Most common is the formation \nof large haematomas. Scarring may also occur.  \nLearning Objectives:\n1. To learn how to do it. \n2. To become familiar with the possible complications. \n3. To appreciate the advantages of large core needles. \nAuthor Disclosure:\n R.M. Mann: Speaker; Bayer Healthcare. \nA-165 17:00 \nC. MRI-guided biopsy  \nC. Smith; Dublin/IE (csmith@mater.ie) \nBreast magnetic resonance (MR) imaging is the most sensitive modality \navailable to evaluate the breast for cancer. It can detect lesions that are occult \nat mammography and ultrasound. It has a limited sensitivity and the positive \npredictive value ranges between 15 and 40%. Histopathological assessment of \nMR-detected lesions is therefore mandatory. Some of these lesions will be \nvisible at second-look ultrasound an d can be biopsied sonographically. A \nsignificant number however will only be discernable on MR, and MR-guided \nbiopsy is therefore the sampling technique of choice. MR biopsy has become \nan essential component of any breast imaging practice. Several MR-biopsy \ntechniques are available including the grid-localising, pillar and post and the \nfreehand techniques. The technique for preparing and performing a MR-guided \nvacuum-assisted biopsy using the grid-lo calising technique is reviewed. \nPotential complications, limitations of MR breast biopsy and actions to prevent \nfailure are discussed. Imaging-histologic  correlation is essential to ensure \naccurate sampling. Clip placement and follow-up imaging should be performed \nto ensure sampling, including ultrasound correlates. Finally, new developments \nin MR-guided therapeutic interventions are discussed.  \nLearning Objectives:\n1. To learn how to do it. \n2. To become familiar with the possible complications. \n3. To learn about the potential of MRI-guided treatment. \n16:00 - 17:30 Room F1  \nJoint Course of ESR and RSNA (Radiological Society of North \nAmerica): Emergency Radiology  \nMC 722  \nAbdominal emergencies  \nModerators:  \nS.E. Mirvis; Baltimore, MD/US \nA. Palko; Szeged/HU \nA-166 16:00 \nA. Abdominal injuries  \nA. Palko; Szeged/HU (palkoand@gmail.com) \nAbdominal injuries require a timely and reliable diagnosis to prevent potentially \nlethal outcomes. The armoury of clinical  tools (physical examination, lab tests) \ndoes not fulfil these criteria, since they are either not fast or not reliable. \nImaging diagnostic modalities help the clinician to acquire the necessary \namount of information to initiate focused and effective treatment. However, the \nselection of the appropriate imaging algorithm, modality and technique, as well \nas the precise detection and interpretation of essential imaging findings are \nfrequently challenging, especially because the circumstances, under which \nthese examinations are performed (open wounds, bandages, non-removable \nlife-supporting equipment, lack of patient cooperation, etc)., are frequently less \nthan optimal. Knowledge of critical imaging signs, symptoms and the role they \nplay in the evaluation of the patient's condition, as well as fast decision-making \nand ability to closely cooperate with the clinicians are skills of key importance \nfor radiologist members of the trauma team.  \nLearning Objectives:\n1. To understand the significance of injury mechanism and its role in the \nformation of abdominal lesions and their complications. \n2. To learn about the role of proper imaging techniques and diagnostic \nalgorithms in the prompt diagnosis of abdominal injuries. \n3. To learn more about typical and unusual findings of various abdominal \ntraumatic conditions. \nA-167 16:30 \nB. The enemy within: non-traumatic abdominal emergencies  \nR.J. Zagoria; San Francisco, CA/US (Ron.zagoria@ucsf.edu) \nThis presentation will describe the technique and important findings for CT \nstone studies as well as the accuracy of this study. An explanation of when IV \ncontrast should be given to augment a CT stone study and findings of GU and \nnon-GU diseases that can mimic symptoms of stone disease will be provided. \nExamples and descriptions of acute mesenteric vascular abnormalities, bowel \n\nA B C D E F G S39  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nobstruction and infectious conditions will be included. Ways to differentiate and \ncategorise emphysematous infections for proper treatment will be described. \nLower tract emergencies will also be illustrated and described. A systematic \napproach to evaluating abdominal CTs will be described to avoid mistakes.  \nLearning Objectives:\n1. To learn how to better analyse CT scans for non-traumatic causes of \nabdominal pain. \n2. To learn about the CT signs and causes of bowel ischaemia. \n3. To learn about the CT findings of common causes of an 'acute' abdomen. \n4. To learn about the imaging findings of acute, non-traumatic urinary tract and \nGI tract emergencies. \nA-168 17:00 \nC. Interactive case discussion  \nA. Palko1, R.J. Zagoria2; 1Szeged/HU, 2San Francisco, CA/US\nUsing cases and an audience response system, this segment of the course will \ngo over the optimal imaging approach for patients presenting with acute \nabdominal pain and abdominal injuries. CT findings will be emphasised. Key \nimaging findings of traumatic and nontraumatic causes of acute abdominal \npain including gastrointestinal tract and urinary tract pathology will be \nexplained. A systematic approach for the imaging evaluation of patients with \nabdominal emergencies will be illustrated and explained including proper scan \nprotocols and analysis of imaging findings. Imaging diagnosis of blunt and \npenetrating abdominal injuries, urinary tract obstruction, infection, bowel \nobstruction, and ischemia will be emphasised.  \nLearning Objectives:\n1. To learn how to better analyse CT scans for traumatic and non-traumatic \ncauses of abdominal pain. \n2. To learn about the CT signs and causes of bowel ischaemia and injuries. \n3. To learn about the CT findings of common causes of traumatic and non-\ntraumatic 'acute' abdomen. \n4. To learn about the imaging findings of acute, traumatic and non-traumatic \nurinary tract and GI tract emergencies. \n16:00 - 17:30 Room F2  \nSpecial Focus Session  \nSF 7a  \nRenal artery denervation in the \nmanagement of resistant hypertension  \nA-169 16:00 \nChairman's introduction  \nF. Fanelli; Rome/IT (fabrizio.fanelli@uniroma1.it) \nTranscatheter renal denervation represents a novel therapy for treating \npatients with treatment-resistant hypertension, leading to higher risk of major \ncardiovascular events. An overview of sympathetic nervous system anatomy, \nphysiology and physiopathology will be followed by a description of the \ntechnical aspects of renal denervation. First, results in patients with therapy-\nresistant hypertension look very promising. However, these data need to be \nconfirmed. Importantly, long-term efficacy and safety need to be assessed. As \na consequence, the treatment cannot be considered, at the moment, standard \ntherapy. Future studies need to address other disease conditions characterised \nby sympathetic hyperactivity, including heart failure, chronic kidney failure and \nothers. It is a general opinion that in the near future the treatment will also be \napplied to lesser severe hypertensive patients. Future studies should also \ninclude formal cost-effectiveness analyses.  \nSession Objectives: \n1. To understand resistant hypertension and sympathetic nervous system \npathophysiology. \n2. To understand the principles of patient selection. \n3. To become familiar with the principles and the selection of devices. \nAuthor Disclosure:\n F. Fanelli: Consultant; WL Gore & Associates, Medtronic, Cook. Speaker; WL \nGore & Associates, Medtronic, Cook, Covidien. \nA-170 16:05 \nResistant hypertension and sympathetic nervous system  \nM. Sapoval; Paris/FR (marc.sapoval2@egp.aphp.fr) \nHypertension is the most frequent cardio vascular disease and is responsible \nfor most strokes, cardiac failures, and renal failures. Control of blood pressure \nusing medical treatment is usually achi eved by employing different classes of \ndrugs. Resistant hyperension is defined by a patient taking 3 drugs and still \nhaving blood pressure higher than 140/90 mm Hg. The data obtained from a \ngeneral population living in the USA between 2003 and 2008 indicate that \nresistant HT is observed in approximately 9% of treated HT patients. Patients \nwith resistant HT can suffer from target organ damage and from the early onset \nof cardiovascular complications, leading to an increase in morbidity and \nmortality. It has been shown that the CV prognosis is directly related to the BP \nlevel, which justifies the treatment of resistant HT in order to obtain BP control \nIn resistant hypertension. It is recognised that there is sympathetic over activity \nand previous experience of surgical denervation has confirmed this \nphysiopathological evidence. Recent experience with percutaenous renal \ndenervation has shown improvement of blood pressure level in patients \npresenting with resistant hypertension. Man y clinical trials are ongoing to try to \nbetter understant the role of renal denervation in the management of resistant \nhypertension.  \nLearning Objectives:\n1. To understand the pathophysiology of hypertension. \n2. To become familiar with relationship between blood pressure and \nautonomous nervous system. \n3. To learn about the complications associated with resistant hypertension. \nAuthor Disclosure:\n M. Sapoval: Consultant; Medtronic, Cordis, ReCor, Boston. Investigator; \nMedtronic, Cordis, ReCor, Boston. \nA-171 16:28 \nRenal artery denervation: current technologies, indications and \ncontraindications  \nG. Goh; London/UK (gerard.goh@stgeorges.nhs.uk) \nRenal denervation can be achieved by a number of different techniques that \ninclude radiofrequency ablation, intraluminal and high-intensity focussed \nultrasound ablation, chemical ablation and radiation ablation. Radiofrequency \nand ultrasound ablation are currently the most commonly used techniques. \nMost of the evidence to date is derived from studies and trials based on \ndevices that use radiofrequency ablation technology. There are a number of \ncurrently CE-marked devices available and each device differs in the catheter \ndesign, generator design and energy delivery. These device types include \nsingle-point ablation, multi-point ablation, balloon-mounted systems and \nirrigated technology. The indications for renal artery denervation have been \nformulated by various international and European societies based on the \nvarious clinical trials and studies. These indications include patients with true \nresistant hypertension, age 18-85 years, eGFR > 45 ml/min/1.73 m\n2 (MDRD \nformula), single renal arteries with diameter > 3-4 mm with a landing zone of \n20-21 mm depending on the device, no significant renal artery stenosis > 30%, \nno renal artery aneurysm, no previous renal artery angioplasty or stenting and \nthe absence of significant valvular heart disease where lowering blood \npressure will be dangerous.  \nLearning Objectives:\n1. To understand the principles of renal denervation. \n2. To understand the differences between the different systems available. \n3. To learn about indications and contraindications. \nAuthor Disclosure:\n G. Goh: Consultant; Boston Scientific, Covidien. Research/Grant Support; \nCovidien. Speaker; St Jude Medical. \nA-172 16:51 \nProcedural technique and clinical results  \nJ.A. Reekers; Amsterdam/NL (j.a.reekers@amc.uva.nl) \nRenal denervation of the sympatic nerves around the renal arteries is a new \ncatheter technique to treat patients with resistant hypertension. Resistant \nhypertension is seen in about 10%-20% of all patients with hypertension. The \nmechanism of sympatic nerve driven resistant hypertension will be explained. \nThe available techniques for RDN will be discussed, focusing on the pros and \ncons of each technique. Currently, RF ablation, HIFU and cryo-ablation are the \ntechniques under investigation. The technique and physics of renal \ndenervation with radiofrequency ablation will be explained in more detail, \nfocusing on available devices in the market. Patient selection and non-\nresponders will be discussed. The current evidence from the available trials will \nbe reviewed. The future of RDN and the role of radiology and the radiologist \nwill be illuminated.  \nLearning Objectives:\n1. To become familiar with the procedural technique. \n2. To learn about parameters influencing clinical outcome. \n3. To learn how to build a dedicated service. \nAuthor Disclosure:\n J.A. Reekers: Advisory Board; J&J for RDN. \nPanel discussion: How do you start a service?  \n17:14\n\nA B C D E F G S40  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n16:00 - 17:30 Room G/H  \nGenitourinary  \nRC 707  \nRenal and adrenal tumours  \nModerator:  \nM. Moschetta; Bari/IT \nA-173 16:00 \nA. Adrenal masses: a practical approach  \nG. Heinz-Peer; St. Pölten/AT (Gertraud.Heinz@stpoelten.lknoe.at) \nThe adrenal glands are composite endocrine organs consisting of the steroid \nhormone-producing cortex and the catecholamine-synthesising medulla. The \nincreased use of imaging modalities has demonstrated the presence of varying \nsized mass lesions in up to 5% of individuals subjected to CT studies for \nreasons unrelated to adrenal dysfunction. Most of these incidentally discovered \nlesions are non-functioning benign lesions of cortical origin. However, \nincidentalomas may also represent functioning lesions and malignant masses. \nClinical diagnostic and biochemical evaluation is used to further subdivide \nfunctional and non-functional adrenal lesions. F-DOPA has been found to be of \nhigh sensitivity and specificity in PET imaging of pheochromocytoma. CT and \nMR imaging are first choice in characterisation of adrenal lesions. Techniques \nof dual energy CT and histogram analysis may offer additional information. \nPET-CT has been shown to contribute to the diagnostic power, especially in \noncologic patients. Knowledge of the physi ologic appearance of adrenal glands \nin 18-FDG PET is necessary to correctly identify pathologic processes. FDG-\nPET also has the ability to detect metastatic lesions in non-enlarged adrenal \nglands. In addition, FDG-PET has the adva ntage of simultaneously detecting \nmetastases at other sites. The role of MR-DWI and MR-spectroscopy in \ncharacterising adrenal masses has to be defined by further studies. \nDifferentiating benign from malignant adrenal masses using non-invasive \nimaging methods can reduce the need for percutaneous adrenal biopsy in \npatients with underlying malignant disease and the follow-up imaging of \nincidentally detected adrenal adenomas.  \nLearning Objectives:\n1. To become familiar with the different imaging appearances of adrenal \nmasses including pathological relation. \n2. To learn about the different imaging techniques in order to improve \nevaluation of benign versus malignant adrenal masses. \n3. To understand the impact of imaging given the fact that a patient either has \nor doesn't have a known malignancy. \nA-174 16:30 \nB. Staging renal cancer  \nM. Notohamiprodjo; \nMunich/DE (mike.notohamiprodjo@med.uni-muenchen.de) \nRenal cell carcinoma (RCC) is the most common malignant tumour of the \nkidney. As response rates to radiation and nonantiangiogenic chemotherapy \nare low, surgical excision, i.e. radi cal nephrectomy has been the treatment of \nchoice. However novel treatment options have emerged, so that imaging of \nRCC is of increasing interest. Nephron sparing partial nephrectomy has \nbecome an accepted operative option and antiangiogenic agents such as \ninhibitors of tyrosine kinase (TK) and mammalian target of rapamycin (mTOR) \nhave been approved for treatment of advanced RCC. Thus, it has become \nimportant to perform correct local staging and identify patients suitable for \npartial nephrectomy using standardised scoring systems such as RENAL or \nPADUA. Furthermore, optimal imaging strategies for monitoring of advanced \nand metastatic RCC are discussed, as current antiangiogenic therapy \nevaluation in clinical routine is bas ed only on morphological imaging \ninformation, but changes in tumour size may lag behind functional changes. \nFinally, common side effects, i.e. pneu monitis, of vascular disruptive agents \nare addressed.  \nLearning Objectives:\n1. To be able to recognise the CT/MRI/US findings for staging. \n2. To learn about the optimal imaging protocol for the diagnosis and staging of \nrenal cancer. \n3. To understand treatment options and implications. \nAuthor Disclosure:\n M. Notohamiprodjo: Investigator; Novartis, GSK. \nA-175 17:00 \nC. How to deal with small indeterminate renal masses  \nJ.-M. Correas, O. Hélénon; Paris/FR (jean-michel.correas@nck.aphp.fr) \nCharacterisation of renal masses can be performed using three categories with \nrespect to the lesion size and gross architecture: the indeterminate very small \nmasses, the cystic, and solid renal masses. Lesions with diameters below \n10 mm are usually difficult to classify d ue to partial volume effect that prevents \naccurate CT attenuation measurement. In the general population, these lesions \nare likely to be microcysts and do not require further workup. Better \ncharacterisation remains needed in selected patient populations such as \npatients with hereditary renal tumour disease and previous history of renal \ncarcinoma. In this case, MRI combining T2w, Diffusion-Weighted imaging and \nDynamic contrast enhanced sequences or contrast-enhanced US may help \ndifferentiate very small cysts from solid neoplasms. Cystic renal mass \ncharacterisation still relies on Bosniak's classification with 5 categories: benign \n(I) and minimally complicated (II) cysts, indeterminate cystic lesions (IIF and III) \nand malignant cystic masses (IV). Some cystic masses remain unclassified at \nCT because of atypical attenuation characteristics or enhancement properties. \nUS, contrast-enhanced US, and MRI are now playing a key role by providing \nadditional diagnostic information that help distinguish between atypical fluid \nfilled masses and atypical solid neoplasms, especially poorly enhancing solid \npapillary RCC. The characterisation of small solid renal tumours starts at CT \nwith the identification of macroscopic fat, a typical feature of angiomyolipoma. \nIn the case of non-fatty indeterminate renal neoploasms, percutaneous-guided \nbiopsy can be performed when accurate characterisation is needed before \nsurgery or when renal metastases or lymphoma are suspected.  \nLearning Objectives:\n1. To become familiar with the various appearances of small indeterminate \nrenal masses. \n2. To learn about the respective roles of US, CT and MR imaging in \ninvestigating small renal masses. \n3. To learn the main pitfalls in assessing small renal masses. \n16:00 - 17:30 Room I/K  \nSpecial Focus Session  \nSF 7b  \nImaging biomarkers in cancer drug \ndevelopment  \nA-176 16:00 \nChairman's introduction  \nB.E. Van Beers; Clichy/FR (bernard.van-beers@bjn.aphp.fr)\nDrug development being a complex and costly process, there is an increasing \nneed for imaging biomarkers to take go/no go decisions in the early clinical \nphases. The RECIST criteria based on tumour size measurements at CT are \ncurrently used for this purpose. However, additional functional and molecular \nbiomarkers have been developed to assess the early biological effect of drugs \non tumours. Development of imaging biomarkers is a structured process in \nwhich new biomarkers are discovered, validated and qualified against \nbiological processes and clinical end points. The validation not only concerns \nthe determination of the sensitivity and specificity, but also the measurement of \nreproducibility. Reproducibility assessments, standardisation of the acquisition \nand data analysis methods and quality control are crucial when imaging \nbiomarkers are used in multi-centre trials. Functional and molecular \nparameters obtained at perfusion imaging, diffusion-weighted MR imaging and \nPET are being developed and validated. The perspectives (earlier assessment \nof response to treatment) and limitations (limited validation and \nstandardisation) of these imaging biomarkers in cancer drug development will \nbe presented. \nSession Objective: \n1. To introduce the general context of imaging biomarkers in drug \ndevelopment. \nA-177 16:05 \nQualification of imaging biomarkers in drug development  \nJ.C. Waterton; Manchester/UK (John.Waterton@manchester.ac.uk) \nMost imaging tests used in cancer drug development are correctly called \nbiomarkers. Important imaging biomarkers include TNM stage, PFS and OR. \nMore recently, pharmacodynamic imaging biomarkers such as FDG-SUV and \nK\ntrans have been introduced. Drug developers are reluctant to use more \nexploratory unvalidated imaging biomarkers (i.e. cannot distinguish a true \nnegative from a false negative). The extensive literature on biomarker \nvalidation mostly refers to biochemical biomarkers extracted as analytes from \nbiospecimens and is unhelpful to radiol ogists. Unlike biospecimen biomarkers, \nthe quality and validity of imaging measurements as biomarkers depend \ncrucially on the use of a diagnostic imaging device, in the presence of the \npatient, in a manner for which the device (a) was not designed, (b) has not \nreceived regulatory approval and (c) may be unfamiliar to the user in the trial \nsite. Technical validation and biological val idation are orthogonal activities. \n''Technical validity'' is confidence that the imaging biomarker can be measured \n\nA B C D E F G S41  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nreliably anywhere in the world. ''Biological validity'' is confidence that the \nbiomarker correctly reports some underlying biology that is important to the \npatient's future clinical outcome. Since the physician always has access to the \npatient's clinical status and history, the biom arker is only useful if it provides a \nbetter forecast than clinical data alone. (If the forecast is near perfect, the \nbiomarker might be a surrogate end point). Technical and biological validations \nare massive undertakings best achieved by consortia, and in particular public-\nprivate partnerships, of which the Inno vative Medicines Initiative in Europe and \nthe Biomarkers Consortium in the USA, are prominent examples.  \nLearning Objectives:\n1. To understand the steps and hurdles in drug development and the need for \nimaging biomarkers. \n2. To consolidate knowledge on the steps towards the qualification of imaging \nbiomarkers. \n3. To learn about the problem of double validation for the use of biomarkers in \ndrug development. \nAuthor Disclosure:\n J.C. Waterton: Employee; AstraZeneca. Research/Grant Support; \nAstraZeneca. Shareholder; AstraZeneca. \nA-178 16:28 \nFunctional imaging in cancer drug development  \nN.M. deSouza; Sutton/UK (nandita.desouza@icr.ac.uk) \nThe standard imaging assessment of tumour response relies on size \nmeasurements, which, with predominantly cytostatic targeted agents, may not \nreflect the drug effect. Functional imaging biomarkers have the potential to \nquantify the biological characteristics of tumours and measure on-target and \noff-target effects that indicate early likelihood of response to a specific therapy, \nwhich can then be used to guide the optimal biological dose and drug \nschedule. Serial, non-invasive assessments of whole tumour are possible. This \nis particularly important in the context of inter and intra-patient tumour \nheterogeneity, as different parts of the tumour and primary vs metastatic \nlesions may be biologically different an d these characteristics may change with \ntreatment. However, functional imaging end points suffer from variability, which \ncan be very significant in a multicentre setting. Strict quality assurance and \nquality control measures need to be implemented at the start of a trial and the \nvariability across centres documented. Data acquisition protocols need to take \naccount of equipment variations. Data analysis methodology needs \nstandardisation of software, central review and preferably double reading of \nscans. Automation may not always prove the most robust and reliable option. \nThis presentation will focus on the factors that are crucial in determining the \ncompatibility of data in multicentre trials with functional imaging end points.  \nLearning Objectives:\n1. To learn about the potential role of quantitative imaging in processes related \nto tumour growth such as cell metabolism, cell death, and vascular function in \nthe assessment of tumour response. \n2. To become familiar with the issues of accuracy, reproducibility and \nstandardisation for using functional imaging biomarkers in drug development. \nAuthor Disclosure:\n N.M. deSouza: Research/Grant Support; CRUK and EPSRC Cancer Imaging \nCentre in association with MRC and Department of Health (England; grant \nC1060/A103334), NIHR funding to the Clinical Research Facility in Imaging \nand the Biomedical Resea. \nA-179 16:51 \nQuantitative nuclear medicine in drug development  \nW. Weber; New York, NY/US \nNuclear medicine techniques can detect and quantify very low concentrations \nof radiolabelled pharmaceuticals in the human body. This allows investigators \nto use nuclear imaging for various purposes during drug development. Nuclear \nimaging can visualise drug targets that are only present in nanomolar \nconcentrations and can thus identify patients most likely for therapies directed \nagainst these targets. A recent example is folate rece ptor SPECT imaging for \nthe selection of patients for treatment with a folate-targeted drug conjugate. In \naddition, nuclear imaging and specifically PET can measure the concentration \nof pharmaceuticals within tumour and normal organs over time. Nuclear \nimaging can also be used to monitor target inhibition, for example the blocking \nof oestrogen receptors by anti-oestrogens. Finally, nuclear imaging can assess \ntumour response to therapy by measuring changes in tumour metabolism or \nproliferation, e.g. with FDG- and FLT PET/CT. This allows an earlier and more \nsensitive detection of tumour response than morphologic techniques. Since \nPET is a whole body imaging technology, PET imaging can also be used to \nstudy the heterogeneity of target expr ession, tissue pharmacokinetics, target \ninhibition and response. PET imaging is now widely available in many \ncountries and has become internationally standardised. It is therefore a robust \nclinical technique that will increasingly be used during drug development.  \nLearning Objectives:\n1. To understand the role and limitations of radiolabelled functional and \nmolecular imaging biomarkers in drug development from the preclinical phase \nto phase 3. \n2. To consolidate knowledge on the specific role of radiolabeled versus other \nimaging biomarkers. \nAuthor Disclosure:\n W. Weber: Advisory Board; Endocyte, MSD. Grant Recipient; Bayer, Philips. \nPanel discussion:  \nWhat new imaging biomarkers are on the horizon in  \ndrug development?  \n17:14\n16:00 - 17:30 Room L/M  \nInterventional Radiology  \nRC 709  \nThe diabetic foot: contribution of \ninterventional radiology  \nA-180 16:00 \nChairman's introduction  \nJ. Lammer; Vienna/AT (johannes.lammer@akhwien.at) \nThere are about 80.000 patients per year in Europe who lose their leg. About \n70% are due to diabetic ischaemic and ulcerative leg problems. In diabetic \npatients the prevalence of foot ulcerations is about 20% and the risk for \ndeveloping foot ulcerations is increase d four times. Diabetic foot problems may \nbe due to neuropathy and malperfusion or a combination of both. The \nneuropathic ulcer and the neuroischaemic ulcer are usually at the plantar \npedis, have a punched-out appearance and are painless. Bone deformities \n(Charcot foot) may be associated. The arterial ulcer is usually at the toe, \nforefoot and ankle, with pale, cold skin and it may be painful. Patients need a \nmultimodality approach involving a diabetologist, vascular specialist \n(angiologist, vascular surgeon, intervent ional radiologist) and podiatrist. Pain \ncontrol, antibiotic and antithrombotic treatment and the treatment of \ncardiovascular risk factors and other co-morbid disease have to be done first. \nIn case of ischaemic pain and ulceration  imaging such as MRA and CTA is the \nnext step. Patients should be referred to a team of vascular specialist early in \nthe course of their disease to plan for revascularisation options. \nRevascularisation is the optimal treatment for patients with an ischaemic and \nneuroischaemic diabetic foot.  \nA-181 16:05 \nA. Pathophysiology of the diabetic foot  \nV. Bérczi; Budapest/HU (Berczi@hotmail.com) \nThe incidence of diabetes mellitus, associated with both predisposing genetic \nand environmental factors, is increasing globally. Several major clinical trials \nhave proved that complications may occur many years following proper \nglycaemic control. Besides peripheral arterial disease, sensory and motor \nneuropathy along with an altered response to infection is of crucial importance. \nRecent studies have showed that microvascular occlusive arterial disease is \nnot a major factor affecting the diabeti c foot; infrapopliteal macrovascular \ndisease and microvascular dysfunction (e.g. arteriovenous shunting, \nprecapillary sphincter malfunction, capillary leakage, venous pooling) are major \ncomponents of impaired perfusion of diabetic foot. There are no randomised \ncontrolled trials analysing the major outcome following endovacular or open \nbypass surgery. The major outcomes, however, were similar in the case series: \n1-year limb salvage showed a median of 85% (interquartile range 80-90%) and \n78% (interquartile range 70.5-85.5%) following open surgery and endovascular \ntreatment, respectively. Limb salvage rat e, however, was considerably higher \nwith either type of revascularisation compared to medical therapy. Negative \npressure wound therapy, hyperbaric oxygen therapy, effective off-loading or \nnonweight-bearing therapies (total contact casts rather than removable \ndevices) have also shown promising results in recent publications. The \nInternational Working Group on the Diabetic Foot (IWDGF) has produced a \nguideline in 2011 on the diagnosis and treatment of peripheral arterial disease \nin patients with diabetes and foot ulcers (Diabetes Metab Res Rev 2012;28 \n(Suppl 1):179-217; Diabetes Metab Res Rev. 2012;28 (Suppl 1):218-24). \nDiabetic foot ulcers should be managed by  a multidisciplinary team (medical, \nsurgical, endovascular, podiatric, nursing and orthotic experts).  \nLearning Objectives:\n1. To undertstand the pathophysiology of the diabetic foot. \n2. To learn about foot care. \n3. To understand the outcomes and complications. \n\nA B C D E F G S42  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-182 16:28 \nB. Imaging and angiosom concept  \nA. Basile; Catania/IT (antodoc@yahoo.com) \nEndovascular arterial revascularisati on is today a solid option in the \nmanagement of CLI with low complication rates and limb salvage rates \ncomparable with surgery. The restoration of adequate blood flow to the foot is \ncrucial to facilitate wound healing, provide pain relief, and avoid whatever \namputations. The angiosome concept was first introduced in 1987 by Taylor \nand further developed by Attinger for pl anning treatment of ischaemic lesions \nof the foot. They divided the foot into six distinct angiosomes, arising from tibial \nand peroneal arteries. Planning the procedure on the basis of this concept will \nyield the best local results of wound healing, compared with the indirect \nintervention. A proper pre-procedure assessment through colour Doppler US \nand DSA of lower limbs is mandatory for guiding the procedure through the \nvessels of the foot. Several studies have evaluated the efficacy of PTA in the \nBTK and the reliability of the angiosome model, approaching 100 % with a limb \nsalvage rate of up to 87% at 12 months. On the basis of these data, we can \nconclude that PTA in diabetic patients with BTK disease is a safe and effective \ntechnique. The first endovascular treatment option is related to the angiosome \nmodel, but when not feasible the indirect technique is also a valid and similarly \neffective procedure.  \nLearning Objectives:\n1. To understand the angiosome concept. \n2. To understand variations in blood supply to the foot. \n3. To apprciate the impact of the angiosome concept on treatment strategy. \nA-183 16:51 \nC. Special techniques for crural endovascular revascularisation  \nS.D. Qanadli; Lausanne/CH (Salah.Qanadli@chuv.ch) \nTo face technical failures, up to 20% in crural chronic total occlusion a decade \nago, different approaches and dedicated devices and technologies have been \ndeveloped in the last few years. Furthermore, percutaneous revascularisations \nare gaining more interest, particularly in patients with critical limb ischaemia not \nonly as first-line treatment, but also as the only possible treatment for complex \nlesions and high-risk patients. Special  techniques for crural endovascular \nrevascularisations are by design techniques rarely used in routine practice, but \ncould offer wide possibilities for the interventional radiologist to solve \nchallenging situations and manage complex lesions. These techniques include \noptions for arterial access (trans-popliteal, trans-tibial, trans-pedal), \napproaches for crossing chronic total o cclusion (assisted endoluminal, lambda \ntechnique, re-entry technologies) and uncommon routes for \nangioplasty/recanalisation (trans-metatarsal loop technique, trans-collateral \ntechniques). Combined antegrade and retrograde approaches have also been \ndeveloped as well as related methods for successful re-entry. Deciding when \nthe patient/lesion is a potential candi date for special techniques is also a \ncrucial issue. The interventional radiologist should be able to convert at any \ntime if necessary the strategy of treatment to another one. He should also be \nable to select the most appropriate technique for the patient in planning \nrevascularisation. Continuous medical education and training is however \nmandatory and for some techniques the learning curve is relatively long.  \nLearning Objectives:\n1. To review different tools for crural endovascular revascularisation. \n2. To learn about different access points. \n3. To discuss how to select the appropriate technique. \nAuthor Disclosure:\n S.D. Qanadli: Consultant; BARD, ABBOTT VASCULAR, CORDIS. Patent \nHolder; Calibrated Vascular Introducer, Multimodality Vascular Phantom. \nResearch/Grant Support; BIOTRONIK, BARD, ABBOTT VASCULAR. \nPanel discussion:  \nIs there a role for pretherapeutic imaging besides catheterisation \nangiography?  \n17:14\n16:00 - 17:30 Room N/O  \nHead and Neck  \nRC 708  \nThe orbit:  \nyou can't see what you haven't learnt  \nModerator:  \nU.Y. Ayaz; Mersin/TR \nA-184 16:00 \nA. Anatomy and commonly encountered postoperative findings  \nN. Hosten; Greifswald/DE (hosten@uni-greifswald.de) \nPathology of the eye and orbit is rare in the radiologist's practice. However, \ndifferential diagnosis is not too difficult if the compartment model is applied. In \nthe orbit, different anatomical structures like the optic nerve as part of the CNS, \nmuscles for moving the globe, vascular structures and glandular tissue are \npresent in a very small space. Each anatomical structure is found in a special \ncompartment; each compartment may give rise to a different group of \npathologies, and only to these pathologies: glioma in the optic nerve, \nrhabdomyosarcoma in the eye muscles, varix in the venous vessels (intraconal \ncompartment) and pleomorphic adenoma in the lachrymal gland. \nUnderstanding the compartments in the orbit is therefore the key to \ndifferentiating different pathological entities. This presentation explains the \norbital anatomy, how the compartments are differentiated, and what changes in \nanatomy treatment may induce.  \nLearning Objectives:\n1. To become familiar with the examination technique according to the clinical \npresentation. \n2. To learn about the anatomic compartments of the orbit. \n3. To understand post-treatment imaging findings. \nAuthor Disclosure:\n N. Hosten: Author; MRI of the Eye and Orbit Thieme Publisher. Grant \nRecipient; INTERREG Program European Comunity. Shareholder; Siemens \nAG. \nA-185 16:30 \nB. Congenital and inflammatory disease  \nT.A. Ferreira; Leiden/NL (T.A.Ferreira@lumc.nl) \nOrbital congenital lesions are uncommon. They can be diagnosed prenatally, \nat birth or later during childhood. Several orbital components can be involved. \nWe will focus on congenital globe lesions (such as staphyloma, coloboma, \npersistent hyperplastic primary vitreo us, Coats disease), the developmental \ncysts such as epidermoids and dermoids, and vascular malformations such as \nlymphangioma and vascular tumours, e.g. capillary haemangioma. Orbital \nInflammatory and Infectious lesions are on the other hand common. Orbital \npseudotumour can involve any area of orbit, being one of the great mimickers \nin the orbit. If located in the orbital apex and/or cavernous sinus, it will be \ncalled Tolosa-Hunt syndrome. Other inflammatory processes in the orbit are \nsarcoidosis and Wegener and Sjogren syndrome. Among infections the most \ncommon is the orbital cellulitis, mostly second ary to a sinusitis and frequent in \nthe urgency setting. The role of the radiologist is to assess whether it is \npreseptal or already postseptal or complicated by a subperiosteal phlegmon or \nabscess. Also of importance is to know and evaluate the possible intracranial \ncomplications. Finally, we will focus on inflammatory and infectious lesions of \nsome specific regions such as the globe and lachrymal gland and give some \nclues for their differentiation.  \nLearning Objectives:\n1. To appreciate imaging findings in congenital globe and orbit disease. \n2. To learn about inflammation and infection. \n3. To become familiar with the complications and pathways of orbital infections. \nA-186 17:00 \nC. Benign and malignant neoplastic tumours  \nW. Müller-Forell; Mainz/DE (wibke.mueller-forell@unimedizin-mainz.de) \nAs more than 100 pathologies can be seen in the orbit, a systematic approach \nis very important to come to the right diagnosis. The main and most helpful \ncriteria of differential  diagnosis of any orbital pat hology is the definition of the \naffected orbital compartment, as some tumours may only or preferentially \ninvolve specific orbital structures. The criteria of the most frequent masses of \nthe globe, malignant melanoma and retinoblastoma are presented as well as \nthose of cavernoma and lymphoma, the main representatives of intraconal \ntumours. There are numerous extraconal neoplasms, only few arising from the \nnasal sinuses, and only a little number of tumours of the optic nerve. The \n\nA B C D E F G S43  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\npresentation will include the most frequent as well as rare, but important \ntumours.  \nLearning Objectives:\n1. To become aquatinted with the differential diagnoses of orbital masses. \n2. To learn an approach to differentiating orbital tumours. \n3. To appreciate the typical imaging findings of benign and malignant orbital \nneoplasm. \n16:00 - 17:30 Conf. Room M3  \nOncologic Imaging: Follow-up of Systemic and Local Therapies  \nCC 718  \nImaging after systemic therapies: the \nstandards  \nModerator:  \nM. Nadrljanski; Belgrade/RS \nA-187 16:00 \nA. RECIST criteria  \nY. Menu; Paris/FR (yves.menu@sat.aphp.fr) \nThe routine practice of oncologic imaging requires standardisation, which \nmeans that we need to harmonise technical protocols and agree on the \nmeaning of selected words for the radiological report. The words \"Response, \n\"Progression\" and \"Stable disease\" are precisely defined according to \ninternationally accepted thresholds and criteria. Although the rules are quite \nsimple and rather easy to apply, they are very efficient in the classification of \nthe response to treatment, and therefore for the medical decisions. However, \nthe role of the radiologist is not limited to measurements and calculation. The \ndetection of new lesions may be challenging and requires experience. The \ndifferential between cancer progression and complications of the treatment \nmight be very difficult and requires an adequate communication with the \nreferring clinician. Overall, most of the decisions taken by the clinician will be \nrelated to imaging results, stressing the importance of adequate protocols and \nreports.  \nLearning Objectives:\n1. To consolidate knowledge on the evaluation of solid tumour response. \n2. To learn some tips and tricks to help bring RECIST to everyday practice. \n3. To understand the advantages and limitations of RECIST. \nA-188 16:30 \nB. PERCIST: evolving considerations for PET response criteria in solid \ntumours  \nT.F. Hany; Zurich/CH (thomas.hany@gmail.com) \nIn solid as well as non-solid tumours, PET/CT imaging using 18-fluoro-\ndeoxyglucose (FDG) has demonstrated the ability to a) correctly stage disease, \nb) demonstrate therapy response and c) predict therapy outcome. FDG uptake \ncan be measured objectively; however sev eral factors in the standardisation \nprocesses of tracer application, image acquisition and post-processing are \nneeded for reproducibility. The term standard uptake value (SUV) \nmeasurement is used for compensating the influence of injected dose, decay \ntime and body mass and represents FDG uptake in any selected pixel of the \nimage. For therapy assessment, drop in FDG uptake represents tumour cell \nkill, notably a negative PET scan does not exclude viable tumour cells but \noverall has a better outcome. PET response criteria in solid tumours (PERCIST \n1.0) have been introduced to refine previously established PET response \ncriteria by EORTC. Major changes concern the use of lean body mass-based \nSUV (SUL), SULpeak measurement in a fixed ROI, use of only a single target \nlesion and normalization to liver uptake. Metric measurements in CT \ncomponent of the PET/CT as an intrinsic asset like in RECIST 1.1 have not yet \nbeen introduced, but might be crucial in the future. The proposed PERCIST 1.0 \ncriteria are not yet standard, since se veral limitations hamper its general use \nbut may improve metabolic tumour response assessment.  \nLearning Objectives:\n1. To learn about the evaluation of solid tumours through metabolic imaging. \n2. To understand the benefits of metabolic imaging. \nA-189 17:00 \nC. Evaluation of brain tumours  \nC. Majós; Barcelona/ES (cmajos@bellvitgehospital.cat) \nMalignant gliomas (WHO grade III and IV) are the most common primary \ntumours of the brain. According to consensus guidelines, the standard of care \nof these tumours includes maximal safe surgical resection followed by \ncombined treatment with chemoradiotherapy. Radiological assessment is \ncritical in the follow-up and should be performed at four different times: 1. \nWithin 72 hours after surgery, an early post-operative MRI must be done to \nevaluate residual tumour and to be used as baseline for follow-up. 2. Two to \nsix weeks after completing radiotherapy, a new MRI examination is \nrecommended to evaluate the response to treatment. Four possibilities are \nenvisaged according to the RANO criteria: complete response, partial \nresponse, stable disease or progressive disease. The evaluation of this first \nMRI examination after RT is challenging and the pseudoprogression \nphenomenon can appear. Advanced MR techniques may be of help in this \nrespect. 3. Additional follow-up should then be performed by MRI every 2 to 4 \nmonths to rule out clinically silent progression. 4. In any case, an MRI \nexamination must be completed when there is a clinical suspicion of \nprogressive disease. Several options for treatment can be offered when \nprogressive disease is detected, including antiangiogenic drugs. Evaluation of \nresponse to these drugs is challenging too, and the pseudoresponse \nphenomenon can then appear. Due its complexity, it is recommended that the \nmanagement of malignant gliomas be performed in the context of \nmultidisciplinary teams and that the radi ologists are strongly involved in these \nteams.  \nLearning Objectives:\n1. To learn about the evaluation criteria for brain tumours. \n2. To become familiar with the evaluation of brain tumours after treatment with \nvarious therapies. \n16:00 - 17:30 Board Room A  \nSpecial Focus Session  \nSF 7c  \nEducational challenges for radiographers  \nA-190 16:00 \nChairmen's introduction  \nG. Paulo1, L. Bonomo2; 1Coimbra/PT, 2Rome/IT\nWe are facing complex times with no pa rallel in human history. The worldwide \neconomic crisis, in combination with a non-regulated process of globalisation, \nis pressuring countries to change their social and political model. These \nchanges are affecting academic institutions and the health-care sector. Higher \neducation was always more internationally open than most sectors because of \nits immersion in knowledge, which was never worried about country juridical \nboundaries. It is well recognised that it was the knowledge created by \nuniversities research that contributed to the development of societies. We, as \nEuropean citizens, must be able to transmit the message that having more \nknowledge and being capable of understanding better the world we live in will \nmake us stronger, more successful and more competitive. European academic \ninstitutions must be prepared for this shift of paradigm and understand that \nthey are no longer educating only for their country but for the globalised world. \nIt is also important to bear in mind that developed health-care systems are \nsuffering several pressures and a call for a new inter-professional collaboration \nconcept is needed, based on each one's roles and responsibilities, towards a \nbetter and more efficient health-care de livery for the patients. In this session, \nthe invited speakers will give us an overview about the challenges that \nacademic Institutions will face in the near future and the way they must adapt \nto become more attractive and at the same time guarantee that radiographers \nand radiologists are educated and trained according to the highest professional \nstandards.  \nSession Objectives: \n1. To appreciate the challenges that academic institutions must face in order to \neducate graduates with the ability to work internationally and to actively \ncontribute to the healthcare sector of the future. \n2. To explore innovative approaches in education and assessment. \n3. To highlight the importance of inter-professional collaboration in order to \nensure that graduates are ready to meet the demands of the modern \nhealthcare sector. \nA-191 16:05 \nChallenges in undergraduate education  \nL.J.O.C. Lanca; Lisbon/PT (luis.lanca@estesl.ipl.pt) \nRadiographers operate a wide range of sophisticated equipment and perform a \nrange of techniques in several radiological procedures. They are responsible \nfor the radiation delivered to the patient while assuring safety and image quality \nat an acceptable level for an accurat e diagnosis. Education and training in \nradiography, in line with the constant technological developments, is a \nrequirement to be fulfilled by higher education institutions (HEI). This is of \nmajor importance in undergraduate education where radiographers learn to \nplay an effective role as healthcare  providers in planning, preparing and \nperforming accurate and safe radiological procedures within the diagnostic or \ntherapeutic field. The European Qualifications Framework (EQF) for \n\nA B C D E F G S44  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nradiography, in terms of the development of knowledge, skills and \ncompetences, provides a European standard for the development of \nradiography learning outcomes at EQF level 6. This constitutes an opportunity \nto develop, tune, advance and promote standards of radiographic practice, \neducation and research throughout Europe. The EQF provides guidance to \nincrease the educational and profession al recognition of radiography in \nEurope. At a European level, the cooperation between HEI in undergraduate \nradiography education would be an opportunity to provide discussions of \nmutual concern, explore new perspectives and views of different cultures, and \nalso share learning and teaching metho ds. International cooperation is an \nopportunity to improve and provide the harmonisation of education regarding a \nprofessional group that plays an effective  role in healthcare in their field of \ncompetence and expertise.  \nLearning Objectives:\n1. To understand radiography undergraduate education requirements and how \nthey meet current challenges in healthcare. \n2. To appreciate the European Qualifications Framework for radiography in \nterms of the development of knowledge, skills and competences. \n3. To highlight the importance of international cooperation in undergraduate \nradiography education. \nA-192 16:28 \nInnovative approaches to educational enhancement: teaching and \nassessment  \nJ. Mc Nulty; Dublin/IE (jonathan.mcnulty@ucd.ie) \nThere is a vast amount of evidence available from the published literature that \nhigher education institutions continue to explore innovation in both teaching \nand assessment practices. This is especially true of health professional \nprogrammes as evidenced by the abundance of literature relating to medicine, \nnursing, radiography and other allied health professions. Such higher \neducation, health professional programmes would appear to be more \ninnovative than many other disciplines often as a direct attempt to mirror the \ndynamic clinical environment in which most graduates will work. There are, \nhowever, challenges associated with any such educational innovations and \nnovel approaches to delivery and assessment. These specific challenges must \nbe carefully considered in parallel with the larger challenges facing higher \neducation institutions, both nationally and internationally, along with the \nprofessions which they contribute to. Through a case study approach, \nsupported by published peer-reviewed literature, institutional reports and \nresearch, this presentation will consider international best practice in education \nalong with the value of collaborative, inter-professional approaches to teaching \nand assessment.  \nLearning Objectives:\n1. To understand the factors influencing the change in approaches to teaching \nand assessment as evidenced by the published literature. \n2. To become familiar with international best practice in teaching and \nassessment. \n3. To appreciate the value of inter-professional collaborative approaches to \nboth teaching and assessment. \n4. To understand and appreciate approaches to teaching and assessment from \nthe students perspective. \nA-193 16:51 \nPerception of changes: the radiologist's point of view  \nB. Ertl-Wagner; Munich/DE (Birgit.Ertl-Wagner@med.uni-muenchen.de) \nThe European Training Curriculum for Radiology is a living document that was \nlast revised in March 2013. It outlines the post-graduate training for physicians \nwho want to specialise in radiology. The ESR recommends a 5-year \npostgraduate training period to become a radiologist divided into 3+2 years \n(level I and II training). In order to subspecialise in an area of interest, further \ntraining is necessary (level III training). With a changing medical environment \nand increasing economic pressures, both radiologists and radiographers face \nchallenges. In order to succeed, both groups will need to stand together and \nfocus on synergies, while minimising areas of conflict.  \nLearning Objectives:\n1. To become familiar with the European Training Curriculum for Radiology. \n2. To evaluate the differences in training for radiologists and radiographers. \n3. To understand the best way towards collaboration between radiologists and \nradiographers. \nPanel discussion:  \nJoint approaches by radiologists and radiographers:  \nthe key to success  \n17:14\n16:00 - 17:30 Room P  \nVascular  \nRC 715  \nDialysis fistula: imaging and intervention  \nModerator:  \nH.I. Manninen; Kuopio/FI \nA-194 16:00 \nA. Assessment of vascular access malfunction  \nR. Uberoi; Oxford/UK (raman.uberoi@orh.nhs.uk) \nHaemodialysis accesses have become the most commonly performed type of \nvascular surgical procedure. However, only 50% of all haemodialysis accesses \nremain patent at 3 years. Autogenous fistulas have a higher rate of primary \nfailure compared to prosthetic grafts (50% vs. 15%), but the long-term patency \nof fistulas is superior to that of grafts. Autogenous fistulas fail after a median of \n3 to 7 years, whereas prosthetic arteriovenous grafts fail after a median lifetime \nof only 12 to 18 months. The pathogenic stenoses causing access failure occur \nin various locations, but the most common site in prosthetic arteriovenous \ngrafts is at the anastomosis between the graft and outflow vein, as identified in \n47% (23,246) to 60% of cases, or in the outflow vein itself in autogenous \narteriovenous fistulas. Clinical assessment alone will detect a large number of \nfailing fistulas. By assessment of the thrill, pulse character, palpation of the \nfistula itself, excessive ble eding and difficulty needling a fistula may all indicate \na failing fistula. If the venous pressures during haemodialysis exceed 120 mm \nHg, fistula flow falls to < 500 ml/min, graft flow decreases to < 650 ml/min, or \naccess blood flow falls by more than 25%. A fistulogram is recommended if \nmonitoring or surveillance suggests that thrombosis is either imminent or has \nalready occurred. Duplex can be used to assess the fistula, but cannot \nvisualise the central veins. MR and CT venography has also been used in \nmany patients successfully.  \nLearning Objectives:\n1. To learn about the imaging features of the malfunctioning vascular access. \n2. To learn about screening protocols and the results of screening. \n3. To learn about the most common problems and how to detect them. \nA-195 16:30 \nB. Treating the stenosed access  \nD. Henroteaux; Liège/BE (denis.henroteaux@chrcitadelle.be) \nTreatment of symptomatic stenosis of vascular access is essential as it can \nlead to thrombosis and loss of vascular access. But treatment can lead to \nrestenosis. The treatment of stenosis remains a challenge which requires a \ngood knowledge of different materials (guidewire, catheters, balloons and \nstents). Though the pathophysiological mechanism of stenosis is different for \nnative fistulas, grafts or restenosis, the treatment technique remains the same. \nThe basic principle is the use of high inflation pressure balloon angioplasty. \nWhatever the material used, the key is to have no residual stenosis greater \nthan 30%. So far, no study has demonstrated the superiority of the \"new\" tools \n(cutting balloon, drug-eluting balloon, cryotherapy) regarding restenosis. \nExcept perhaps for anastomotic grafts stenosis, stents should be reserved to \ntreat complications or failure of balloon angioplasty. The stents indications are \nresidual elastic stenosis, wall obstr uctive damage, acute rupture during \nangioplasty, aneurysm or restenosis. Complications of stenosis treatment are \nrare, but can lead to the loss of vascular access. The main complications are \nthrombosis and acute rupture. As with any treatment, there have been \ncontraindications: infection, distal isc haemia, high flow, newly created or \nsurgically revised access ( < 6 weeks). When dealing with a vascular stenosis \naccess, never compromise on the future, but think about the surgical \nalternative. So, the management of stenosis vascular access must also be \nmultidisciplinary.  \nLearning Objectives:\n1. To learn about treatment techniques, material and equipment. \n2. To become familiar with the difference between treating dialysis fistulas and \ngrafts. \n3. To learn about complication management. \n\nA B C D E F G S45  \nFriday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-196 17:00 \nC. Treating the thrombosed access  \nL. Turmel-Rodrigues; Tours/FR (luc.turmel@wanadoo.fr) \nPercutaneous treatment of a thrombosed dialysis access can be extremely \nchallenging. The major concern does not stem from the fact that the procedure \ncan be complexly long, but arises rather from the management of its \ncomplications, which can be serious particularly when the access is branched \nonto the brachial artery. Access infecti on is an absolute contraindication. \nTemporary contraindications include flui d overload and severe hyperkalaemia.  \nPercutaneous thrombectomy of grafts is very well standardised and \npredictable: size of 6 mm, well palpable wall which is easy to needle, small \naverage clot burden, and an underlining stenosis almost always found at the \nvenous anastomosis. Thrombectomy of AVFs is subject to variations in \napproach and technical difficulties depending on their anatomical \nparticularities. \nAll techniques employed follow 2 rules: first, the removal of thrombi and, \nsecond, dilation of the stenosis responsible for the thrombosis. Heparin and \nantibiotics must be injected. The basic principle is to place in the arterialized \nvein or graft 2 introducer sheaths in opposite directions to work on both the \nvenous outflow and arterial inflow. Thrombus lysis or removal can be achieved \nby mechanical, pharmacological and pharmaco-mechanical methods. All \ntechniques may work in grafts given that the modest amount of thrombus \n(3.2 ml on average) can be simply pushed into the lungs. Prosthetic grafts are \nthus easier to declot than native fistulas, but they are much more prone to early \nrethrombosis. Thrombi located at the arteriovenous anastomosis form a firm \nand rubbery plug, frequently and notoriously resistant to thrombolysis.  \nLearning Objectives:\n1. To learn about treatment techniques, material and equipment. \n2. To become familiar with the difference between treating dialysis fistulas and \ngrafts. \n3. To learn about complication management. \n\nA B C D E F G S46  \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n\u0012\u0014!\"\u001f\u0016\u0014#\u0002\u0001\u0010\u0014\u001f\u0015\u0019\u0001\f\u0001\n\nA B C D E F G S47  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n08:30 - 10:00 Room A  \nInteractive Teaching Sessions  \nE³ 820a  \nThoracic changes after treatment  \nA-197 08:30 \nA. Drug-related conditions  \nT. Franquet; Barcelona/ES (tfranquet@santpau.cat) \nDrug-induced lung disease is an increasingly common cause of morbidity and \nmortality. The diagnosis is based on clinical history and consistent radiologic \nfindings. Lung biopsy is performed in a small percentage of cases. High-\nresolution CT may demonstrate different parenchymal patterns including \ndiffuse alveolar damage, acute or chronic alveolar haemorrhage, nonspecific \ninterstitial pneumonia (NSIP), hypersensitivity pneumonitis, organising \npneumonia, and eosinophilic pneumonia. The imaging and histologic \nmanifestations are often nonspecific. A systematic approach to the radiological \nevaluation of drug-related lung diseas es is essential and includes not only \nchest imaging pattern recognition, but also  integration of available clinical \ninformation.  \nLearning Objectives:\n1. To understand pulmonary changes related to treatment. \n2. To understand the mechanisms of injury to the lung in drug related \nconditions. \nAuthor Disclosure:\n T. Franquet: Author; Amirsys/Elservier. \nA-198 09:15 \nB. Device-related conditions  \nG.R. Ferretti; Grenoble/FR (GFerretti@chu-grenoble.fr) \nIn this interactive session, we will present and discuss several cases illustrating \nthoracic changes after instrumental procedures in the thorax such as surgery, \nradiofrequency ablation, interventional endoscopy, and intensive care. \nRadiologists have an important role in assessing the results of these \nprocedures as well as in depicting the complications. However, knowledge of \nthe normal appearance after those procedures has to be presented.  \nLearning Objectives:\n1. To understand changes related to lines and wires in ICU patients. \n2. To learn about findings related to surgery. \n08:30 - 10:00 Room B  \nEmergency Radiology  \nRC 817  \nPolytrauma: redefining imaging issues for \nmanagement priorities  \nA-199 08:30 \nChairman's introduction: advanced imaging, logistics and management \npriorities in patients after polytrauma  \nH. Alkadhi; Zurich/CH (hatem.alkadhi@usz.ch) \nThe initial imaging workup of polytrauma patients remains challenging. Besides \nhardware requirements, workflow issues continue to evolve, with the current \nfocus on the introduction of whole body CT into the early resuscitation phase of \nseverely injured patients as a standard and basic diagnostic imaging method. \nThis session is aimed at a thorough discussion on the requirements for \nadvanced imaging in the early clinical situation in emergency radiology. Focus \nis directed on the issues of radiation dose as well as on CT and contrast media \nprotocols.  \nA-200 08:40 \nA. Chest and abdomen  \nM. Scaglione; Castel Volturno/IT (mscaglione@tiscali.it) \nThoraco-abdominal injuries are a significant cause of death in the \npolytraumatised patients. Early recognition and communication of life-\nthreatening thoraco-abdominal injuries is the major task of the radiologists \ninvolved in the emergency room. Although most of these patients reach the \nhospital prior to dying, lethality continues to remain high. Heart, thoracic great \nvessels, trachea, bronchus, pleura, lung, diaphragm, \nabdominal/retroperitoneal, vascular and solid organ injuries are potential cause \nof death. Any appropriate surgical/interventional management approach must \nbe carried out \"around the clock\", before thoraco-abdominal injuries reach the \nlevel of clinical evidence. On the other hand, non-operative management has \nactually become the standard of care for the most serious thoraco-abdominal \ninjuries. These goals become feasible if a correct contrast-enhanced MDCT \ndiagnosis, in a dedicated facility in which the trauma team works effectively 24 \nh a day, 7 days a week, is performed. Thus, in this lecture, the most serious \nthoraco-abdominal injuries will be illustrated, with special emphasis on \nvascular/injuries as well as the value of post-processing techniques, protocols, \npitfalls, tips and tricks. Furthermore, the importance of a rational and integrated \nimaging approach will be pointed out and, finally, the role of the radiologist in \nthe emergency room will be emphasised.  \nLearning Objectives:\n1. To become familiar with the most important imaging findings and their \nimpact on patient management. \n2. To understand common classification systems, trauma scoring systems and \ntheir impact on patient management. \n3. To learn about typical and atypical imaging findings. \nA-201 09:00 \nB. Spine and pelvis  \nG. Schueller; Bülach/CH (gerd.schueller@spitalbuelach.ch) \nSpinal and musculoskeletal trauma account for significant morbidity in severely \ntraumatised patients. Traumatic injuries to the spine encompass a variety of \nfrequently occurring disorders and primarily result in stable injury. Although \nrare, unstable disorders comprise inju ries to the bone, the discs, and the \nligaments. In the majority of cases, spinal  cord injuries result in devastating \nmedical and social consequences. Severe musculoskeletal disorders usually \nare the result of high-impact accidents, such as motor vehicle accidents and \nfalls from a height. For instance, the injured pelvic ring causes one of the most \nlife-threatening conditions that the trauma team must handle. Pelvic injuries are \noften associated with severe arterial, venous, and/or osseous bleeding. \nRadiography is no longer recommended as the primary screening modality in \nspinal and pelvic trauma for adults. Despite the radiation dose burden of CT, \npatients with a high risk of spine injury receive MDCT imaging, as it is the \nmethod of choice. MR imaging is indicated primarily when patients present with \nmyelopathy, and to search for spinal cord pathology. Interventional radiology \nplays a major role in the therapy of complex traumatic pelvic disorders.  \nLearning Objectives:\n1. To become familiar with the pathomechanisms and classification of spinal \nand pelvic trauma treatment options. \n2. To become familiar with the image interpretation of the spine and the pelvis. \n3. To learn about typical imaging findings based on CT and MR imaging. \nA-202 09:25 \nC. Extremities  \nU. Linsenmaier, L. Geyer; Munich/DE \n(Ulrich.Linsenmaier@kliniken-pasing-perlach.de) \nExtremity injuries in patients after polytrauma can be complex and are initially \noften difficult to be fully diagnosed. Em ergency radiology diagnosis is today \nmostly based on a standardised whole body CT (WBCT), which can be \nextended with CTA and adapted to cover extremity injuries. Extremity injuries \ncomprise: fractures of (1) long bones, (2) articular joints, (3) complex fractures \nof hands and feet, (4) vascular, (5) soft tissue, (6) nerve and plexus injuries \nand (7) amputations. Imaging protocol: *MDCT is indicated in all major and \ncomplex bony fractures and is carried out early or integrated with WBCT. CTA \nusing MIPs and MPRs enables a thorough workup. * The role of US and CR is \nlimited. * The role of MR and MRA (in stable patients only) is to evaluate \nunstable articular injuries, injuries of tendons or major ligaments and nerve and \nplexus injuries). * The role of DSA is mostly for intervention. Clinical findings \nand findings from WBCT determine how to proceed, \"first things are done first\" \nin a priority-oriented clinical algorithm. Treatment of extremity injuries must \ntherefore be priority oriented and carefully planned in the context of possible \nconcurrent injuries and a possible risk of multi-organ failure (MOF).  \nLearning Objectives:\n1. To become familiar with imaging strategies, the role of CR, CT and MR. \n2. To understand common classification systems and their impact on patient \nmanagement. \n3. To learn about typical and atypical imaging findings. \nPanel discussion: How to speed up your diagnoses  \n09:45\n\nA B C D E F G S48  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n08:30 - 10:00 Room C  \nInteractive Teaching Session  \nE³ 820b  \nCentral nervous system changes after \ntreatment: what you need to know  \nA-203 08:30 \nA. Drug-related conditions  \nF. Barkhof; Amsterdam/NL (f.barkhof@vumc.nl) \nSystemic drugs can be used for the treatment of CNS and non-CNS diseases. \nBoth classes can affect the brain inadvertently. Common general drugs that \naffect the brain in a bystander manner are steroids (~1% brain volume \nreduction), recreational drugs (alcohol, cocaine, heroin, XTC), metronidazole \nand anti-epileptic drugs (corpus callosum demyelination) and \nimmunosuppressants like cyclosporine/tacrolimus (PRES/RPLS) and \nmethotrexate. Mechanisms of action include neurovascular compromise, \nfluid/metabolite shifts and toxic effects to myelin of other tissue components. \nAmong CNS-targeted drugs, especially immunomodulating agents may cause \nspecific side effects. Cytokine-release syndromes may occur with broad-acting \nagents such as general T cell antibodies. Specific side effects may occur in \nmultiple sclerosis, where treatment with natalizmumab may cause reactivation \nof JC virus leading to progressive multifocal leukencephalopathy (PML). Upon \nwithdrawal of therapy, this may then evolve into an Immune reconstitution \ninflammatory syndrome (IRIS). In Alzhei mer disease, novel antibodies or \nvaccinations against amyloid may cause amyloid related imaging abnormalities \n(ARIA), which may present with microhaemorrhage on T2* images, or with \nedema and effusion on FLAIR.  \nLearning Objectives:\n1. To understand changes related to systemic treatment. \n2. To learn about CNS treatment agents. \nA-204 09:15 \nB. Imaging of treated brain tumours  \nJ. Alvarez-Linera; Madrid/ES (jalinera@ruberinternacional.es) \nThe objective of this session will be to review the diagnostic value of \nconventional sequences as well as the use of contrast in the monitoring of \nbrain tumours, with special attention to gliomas. Also, we will address the \nadvantages and limitations of advanced techniques: perfusion, diffusion, and \nspectroscopy. Immediately after surgery, the main objective of neuroimaging is \nthe detection of the remaining tumour. It may also be necessary to rule out \ncomplications such as haemorrhage, ischaemia or infection. The fundamental \ntechnique is MRI with contrast in the first 48 hours and also diffusion \nsequences. In late follow-up, the goal is to differentiate the changes secondary \nto treatment of those related to tumour progression or recurrence. In these \ncases, conventional sequences present important constraints and are useful \nstudies of diffusion, perfusion and spect roscopy. During follow-up after \nchemoradiotherapy, the objective is to assess tumour response. The response \naccording to the new RANO criteria will be revised. The combination of \nchemotherapy and radiotherapy, as well as the use of anti-angiogenic drugs \ncauses changes that complicate the assessment of the response to treatment, \nwith cases of pseudoprogression and pseudoresponse. In these cases, \nperfusion techniques, diffusion and spectroscopy can provide relevant \ninformation, although it is necessary to sta ndardise the quantification to make \nits wide use possible.  \nLearning Objectives:\n1. To appreciate CNS manifestations after surgery. \n2. To understand CNS changes after radiotherapy and other non-surgical \ntreatments. \n08:30 - 10:00 Room D  \nGenitourinary  \nRC 807  \nContrast media safety: update  \nA-205 08:30 \nChairman's introduction  \nP. Reimer; Karlsruhe/DE \nThe speakers in this course will update the audience on contrast media safety \nsuch as steps to be taken before contrast administration and present the \nnewest safety guidelines. The first speaker will cover new concepts of non-\nrenal reactions to contrast media explai ning which hypersensitivity reactions \nare allergic and non-allergic. The audience may learn assessing symptoms \naccording to the Ring and Messmer classification and understand the \nimportance of tryptase sampling and skin testing in the follow-up. The second \nspeaker will address NSF. The presentation will review the pathophysiology, \nrisk factors, recent recommendations and prevention of NSF. Patients with \nGFR less than 30 ml/min/1.73 m\n2 have increased risk of developing NSF. Low-\nstability gadolinium contrast media show the strongest association with NSF. \nFollowing existing guidelines on the use of gadolinium contrast agents \nminimises the risk of NSF. Potential long-term harm from gadolinium \naccumulation in the body and legal issues are discussed. The last speakers \nwill cover contrast medium-induced nephropathy with more recently published \nguidelines related to that issue. The presentation will include the definition of \nCIN and the choice of contrast medium and prophylactic measures. Recent \nchanges in ESUR guidelines will be explained. The risk of CIN is considered \nsignificantly lower following iv. CM administration and patients referred for \nenhanced CT are genuinely at risk if they have an eGFR < 45 ml/min/1.73 m\n2.\nVolume expansion with isotonic saline or sodium bicarbonate may be used for \npreventing CIN in at-risk patients.  \nAuthor Disclosure:\n P. Reimer: Investigator; Bayer Health. Speaker; Bayer Health, Bracco. \nA-206 08:35 \nA. Acute non-renal reactions to contrast media: new concepts  \nO. Clément; Paris/FR (olivier.clement@inserm.fr) \nAcute immediate hypersensitivity reacti ons occur within the hour following the \nadministration of contrast media. They can be seen with Iodinated and \ngadolinium-based contrast agents. Over the last ten years, new concepts have \nemerged in the way of understanding, managing and exploring hypersensitivity \nreactions. The clinical appearance is best classified by the Ring and Messmer \nscoring, from Grade 1 (cutaneous and subcutaneous signs) to Grade 4 \n(cardiovascular arrest). The mechanisms involve either true IgE-mediated \nhypersensitivity or non-allergic hypersensitivity. The differential diagnosis in \nfavour of allergy is made on a triad: clinical signs (the more severe, the more \nare the chances to be allergic), elevated tryptase levels in the plasma \n(indicating mastocyte triggering) and positive skin tests performed one month \nafter the reaction. These new concepts induce important consequences in \nmanaging hypersensitivity reactions: be prepared to treat the patient \nadequately, be prepared to draw blood after the reaction to dose tryptase \nlevels, send the patient to a dedica ted allergologist, and forget about the \npreventive role of premedication against severe reactions.  \nLearning Objectives:\n1. To learn which hypersensitivity reactions are allergic and non-allergic. \n2. To learn the clinical symptoms according to the Ring and Messmer \nclassification. \n3. To understand the importance of tryptase sampling and skin testing in the \nfollow-up. \nAuthor Disclosure:\n O. Clément: Board Member; French society of Radiology. \nA-207 08:58 \nB. Nephrogenic systemic fibrosis: from pathophysiology to \nrecommendations  \nH.S. Thomsen; Herlev/DK (henrik.thomsen@regionh.dk) \nGadolinium (Gd) belongs to the lanthanides in the periodic table, all of which \naffect collagen. The ability to hold the Gd ion varies from chelate to chelate, \nwith non-ionic linear chelates being the weakest binders. Transmetalation \n(exchange of Gd with another ion, e.g. zinc) leads to NSF, a horrifying very late \nadverse reaction to some Gd-CM. Since 2007, the various Gd-CM have been \nclassified into 3 groups: high risk (of NS F), intermediate risk and low risk. The \nauthorities have introduced several restrictions on the use of high-risk agents, \nwhich will be followed by every physician in the EU. The agents are \ncontraindicated in 1) patients with severely reduced renal function including \ndialysis, 2) acute renal insufficiency, 3) neonates and 4) pregnant women. \nThey may only be used with caution in patients with moderately reduced renal \nfunction and children less than 1 year old. There must be at least 7 days \nbetween 2 injections in those patients. Renal function must always be \ndetermined by laboratory methods before use of high-risk agents. Women \nshould stop lactation for 24 hours. These agents should never be given at \ndoses higher than 0.1 mmol/kg per examination in any patient. For the \nintermediate and low-risk agents, the restrictions are significantly less; they \nshould only be used with caution in patients with severely reduced renal \nfunction including dialysis. If a physician does not follow these rules, he or she \nwill have legal problems as they have been introduced into the SPC by the \nauthorities.  \n\nA B C D E F G S49  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To understand the underlying pathophysiology. \n2. To learn about the clinical implications of the recent \nrecommendations/guidelines. \n3. To become familiar with legal issues. \nA-208 09:21 \nC. Contrast medium-induced nephropathy and new guidelines  \nF. Stacul; Trieste/IT (fulvio.stacul@aots.sanita.fvg.it) \nThe Contrast Media Safety Committee (CMSC) of the ESUR has updated its \nguidelines on contrast medium-induced nephropathy (CIN). The ACR recently \nupdated its guidelines as well. New guidelines were produced by nephrological \nsocieties. The topics reviewed include th e definition of CIN, the choice of \ncontrast medium, and the prophylactic measures used to reduce the incidence \nof CIN. The CMSC considered it appropriate to keep the definition of CIN that \nwas agreed in 1999. However, nephrologists have recently agreed on a new \ndefinition. In the previous guideline, a number of risk factors were listed (raised \nS-creatinine levels, particularly secondary to diabetic nephropathy, \ndehydration, congestive heart failure, age over 70 years, concurrent \nadministration of nephrotoxic drugs). The significance of these risk factors has \nbeen confirmed and new risk factors were added. The CMSC agreed that the \nrisk of CIN was significantly lower following intravenous CM administration and \nconcluded that patients referred for enhanced CT were genuinely at risk if they \nhad an eGFR < 45 ml/min/1.73m\n2. The previous CMSC guideline suggested \nthe use of low or iso-osmolar CM in patients with risk factors for CIN and the \nCMSC considered that this previous guideline should not be changed. The \nCMSC considered that there was enough evidence to recommend that either \nvolume expansion with isotonic saline or sodium bicarbonate may be used for \npreventing CIN in at-risk patients, while the efficacy of NAC and other drugs in \nreducing the incidence of CIN remained unproven. Guidelines produced by \nother societies provide very similar suggestions, thus further validating these \nrecommendations.  \nLearning Objectives:\n1. To become familiar with newest guidelines on contrast-induced nephropathy \n(CIN). \n2. To understand the future clinical implications of the new guidelines. \nAuthor Disclosure:\n F. Stacul: Advisory Board; GE Healthcare. Speaker; Bracco, GE Healthcare. \nPanel discussion:  \nWhat is the most appropriate radiological approach to patients with \nfalling eGFR and when should contrast media be administered and when \nshould it not?  \n09:44\n08:30 - 10:00 Board Room B  \nPaediatric  \nRC 812  \nAutoimmune disorders in children  \nModerator:  \nM.P. García-Peña; Barcelona/ES \nA-209 08:30 \nA. The joints in juvenile idiopathic arthritis  \nL.-S. Ording Müller; Oslo/NO (lilsofie.ording@googlemail.com) \nJIA is the most common rheumatic entity in childhood and includes a subset of \nchildhood arthritis, all of which are characterised by chronic synovitis with a \npotential risk of progressive joint destructi on. Radiological investigations in JIA \nshould ideally be able to determine the presence and degree of active \ninflammation, precursors of bony destructions and established erosions. \nHowever, there are many pitfalls in the interpretation of joint pathology in \nchildren. Ultrasonography is often the initial tool in the assessment of arthritis \nand can depict joint fluid and synovitis. Erosions and cartilage destruction of \nsmall joints may also be seen. The major problems are standardising the \nimaging technique and the lack of normal standards of anatomy in US in \nchildren. Radiographs can show bone erosions and may depict cartilage loss \nindirectly through joint space narrowing, but are insensitive to inflammation and \nearly joint destruction. MRI is the only imaging modality that can assess all \nrelevant anatomical structures in jo int inflammation and is sensitive to early \ninflammation and destruction. However, large variations in the amount of joint \nfluid, bone marrow oedema-like lesions and changes resembling erosions are \nseen in children and also in healthy individuals. The differentiation between \ntrue pathology and normal findings on MRI in children remains a challenge, \nparticularly in early disease. In this lecture, the role of radiographs, ultrasound \nand MRI and the typical radiological findings in joint pathology in JIA will be \npresented. Current knowledge on validity and reliability of the different imaging \ntechniques in JIA will be discussed.  \nLearning Objectives:\n1. To learn about the different joint lesions in JIA. \n2. To understand when to use US or MRI. \n3. To learn how to recognise the typical imaging patterns. \nA-210 09:00 \nB. The digestive tract  \nE. Alexopoulou; Athens/GR \nInflammatory bowel disease (IBD) is a range of diseases, which includes \nCrohn disease, ulcerative colitis, and  indeterminate colitis. The combined \neffects of the four basic components seem to result in the disease: \nenvironmental changes, genetic factors, intestinal microbiota alterations and \nimmune system deregulation. In children with unknown IBD, US is considered \nto be the first choice imaging technique which is performed before endoscopy. \nBowel wall thickening, location and length of the disease, echogenicity of the \nbowel wall, the presence or not of normal stratification, ulcers, bowel stiffness, \nstricture or distention can often be detect ed with US. Additional information \nabout the surrounding fat and the presence of mesenteric nodes can be \nobtained. The absence of bowel wall thickening has a strong negative \npredictive value. MR enterography is the technique of choice in children with \nknown IBD, as it is a reproducible and well-tolerated examination, lacking \nradiation and providing excellent information about bowel disease. MR \nenterography clearly illustrates: a) bowel loop appearance (fixed, dilated, \nstrictured, pseudo sacculation appearance); b) bowel wall (thickness, focal \nlesions such as ulceration, pseudopolyps and mural abscess, type of signal on \nT2 -W sequences and pattern of enhancement after iv contrast injection); c) \nextramural signs (fibrofatty prolifer ation, \"comb sign\", fistula, abscess, \nmesenteric nodes). CT should be performed in cases where MRI is \ncontraindicated or in acute-emergency situations, when US is inadequate. It \nremains also an examination of choice for abscess drainage, to depict its exact \nextension and select the most appropriate access route.  \nLearning Objectives:\n1. To learn the basics of mechanisms related to autoimmune enteritis. \n2. To appreciate the role of US, CT and MRI. \n3. To become familiar with imaging findings useful in the diagnosis. \nA-211 09:30 \nC. Multiple sclerosis in children  \nC. Adamsbaum, B. Husson, K. Deiva, M. Tardieu; Le Kremlin Bicêtre/FR\n(c.adamsbaum@bct.aphp.fr) \nThe recent criteria for paediatric MS (Mult Scler 2013, 19, 1261-7) and the \nrevised McDonald criteria for adults and adolescent MS allow the diagnosis of \nMS at the time of the first demyelinating clinical event. Brain MRI plays an \nimportant role in those criteria, as it can demonstrate the classical \ndissemination in time and space and helps earlier diagnosis, which is of major \nimportance since the present recommendation in children is to start \nimmunomodulating treatments as soon as diagnosis is established. Among \npaediatric MS, 14% begin before the age of 6 years and 30% before the age of \n10 years, frequently with an ADEM presentation in young children as initial \nmanifestation of MS. However, only 20% of the ADEM indicate MS onset and \nthe most predictive factors should be known, i.e. periventricular, deep white \nmatter, corpus callosum high T2 signal lesions and black holes on T1 \nsequences. MRI evaluation is also instrum ental in differential diagnoses such \nas nonrelapsing ADEM, vasculitis, immunog enetic diseases and occasionally \nleukodystrophies. Finally, brain MRI is useful to evaluate the risk of more \nsevere MS.  \nLearning Objectives:\n1. To understand the difference between children and adults. \n2. To become familiar with imaging findings. \n3. To learn about the principle differential diagnosis. \n08:30 - 10:00 Room E1  \nState of the Art Symposium  \nSA 8  \nRadiology and obesity  \nA-212 08:30 \nChairman's introduction  \nS.A. Jackson; Plymouth/UK (simon.jackson1@nhs.net) \nThe obesity epidemic represents one of the most significant European and \npublic health challenges in the 2 1 st century with prevalence of the disease \nhaving tripled in many countries during the past 30 years. This is resulting in an \n\nA B C D E F G S50  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\never increasing cost to healthcare systems including hospital and in particular \nradiology services which face unique challenges when imaging this group of \npatients. Obesity significantly increases the patient's risk of various comorbid \ndiseases including the incidence of cancer, diabetes, and cardiovascular and \nliver pathology with a multidiscipli nary team approach mandatory for optimal \npatient care. This multidisciplinary symposi um will review the implications of \nthe epidemic with cutting edge, in-depth lectures presented by European \nexperts addressing the epidemiology, role of imaging in the bariatric surgical \npatient as well as the importance of abnormal fat deposition in the liver.  \nSession Objectives: \n1. To learn about the impact of the obesity epidemic on European healthcare. \n2. To appreciate the value of imaging techniques in the management of the \npost-operative bariatric patient. \n3. To understand the role of radiology in fatty liver disease and the importance \nof imaging during subsequent patient surveillance. \nA-213 08:35 \nObesity: causes and consequences to the patient  \nR. Batterham; London/UK (r.batterham@ucl.ac.uk) \nObesity is one of the greatest 2 1 st century public health challenges. Its \nprevalence has tripled in many European Union (EU) countries since the \n1980s. Currently, 52% of EU adult population is overweight and 17% obese, \nand the numbers of those affected continue to rise. Overweight and obesity are \nrisk factors for numerous health problems, including hypertension, diabetes, \ncardiovascular diseases, respiratory pr oblems, musculoskeletal diseases and \nsome forms of cancer. Mortality also increases sharply once the overweight \nthreshold is crossed. Because obesity is associated with higher risks of chronic \nillnesses, it is linked to significant a dditional health care costs and is already \nresponsible for 2-8% of health costs. Changes in our environment are the main \ndriver for this increase in overweight/obese. However, a person's genetic \nmake-up can either increase or decrease their chances of becoming \noverweight. The gastrointestinal tract is the body's largest endocrine organ \nproducing hormones that regulate bodyweight. Dietary modifications, such as \ncaloric restriction, are the first-li ne obesity treatments. However, dieting \nproduces only moderate weight-loss with poor weight-loss maintenance. \nCompensatory gut hormone changes induced by dieting are thought to \ncontribute to the failure of dieting. In contr ast, bariatric surgery is an efficacious \ntreatment modality for obesity, producing durable weight-loss, amelioration of \nobesity-associated co-morbidities and reduced mortality. Consequently, the \nnumber of bariatric procedures undertaken within Europe has doubled in the \nlast 5 years with 112,000 procedures undertaken in 2011. There is increasing \nevidence that surgically-induced alterations in circulating gut hormones \nmediate the weight-loss and metabolic beneficial effects of bariatric surgery.  \nLearning Objectives:\n1. To understand the epidemiology of obesity and its impact on European \nhealthcare provision. \n2. To appreciate the aetiology of obesity and the scientific rational for surgical \ntreatment. \n3. To learn about the effects of obesity on health. \nA-214 08:58 \nImaging of modern surgical procedures and their complications  \nM. Rengo; Latina/IT (marco.rengo@gmail.com) \nWe will illustrate the common bariatric procedures, in particular their normal \nappearance on different diagnostic technique as well as their early and late \ncomplications. We will illustrate the correlation between conventional barium \nstudies and advanced imaging with MDCT and MR. We will explain how to \noptimise MDCT and MR acquisition protocol  according to the clinical indication. \nWe will explain what to evaluate before redo surgery, in particular quantitative \nand functional analysis. We will illustrate the role of interventional radiology in \nthe management of early postoperative complications, in particular in the \nmanagement of patients subjected to gastric banding.  \nLearning Objectives:\n1. To understand the common bariatric surgical procedures and post operative \nimaging appearances. \n2. To appreciate the role of imaging in the assessment of suspected immediate \nand long-term postoperative complications. \n3. To become familiar with the role of interventional radiology in the \npostoperative period, including gastric band follow-up. \nA-215 09:21 \nFat: where it shouldn't be  \nV. Vilgrain1, M. Ronot1, B. Leporcq2, S. Lambert2, B.E. Van Beers1; 1Clichy/FR,\n2Paris/FR (valerie.vilgrain@bjn.aphp.fr) \nNon-alcoholic fatty liver disease compri ses a variety of pathological disorders \nranging from simple steatosis to steatohepatitis. This condition is common in \nthe Western population and is typically associated with obesity and the \nmetabolic syndrome. Its incidence increases dramatically. Diagnosis of fatty \nliver and distinction between simple steatosis and steatohepatitis are keys \nbecause the latter can lead to extensive fibrosis and cirrhosis with an \nincreased risk of hepatocellular carcinoma (HCC). Imaging plays a crucial role \nin diagnosing fatty liver. The two most important imaging modalities are \nultrasound and MR imaging. Ultrasound can exclude major steatosis but lacks \naccuracy to precisely quantify fat, while MR is the most accurate for \nquantification. The technique of reference is MR spectroscopy, but \nsophisticated sequences based on chemical shift principle have been shown \nas accurate as MR spectroscopy. Unfortunately, imaging has still limitations to \nassess the presence of fibrosis and inflammation which are associated with \nsteatohepatitis and functional tools could be of interest. Today, imaging is \ncombined with clinical and biological biomarkers to evaluate the risk of \nsteatohepatitis. Due to the increased risk of HCC and cirrhosis-related \ncomplications in patients with steatohepatitis, patients at risk should be \nenrolled in the surveillance programme.  \nLearning Objectives:\n1. To understand the pathophysiology of fatty liver disease and its link to \ncirrhosis. \n2. To become familiar with the role of imaging in the detection and \nquantification of fat in the liver. \n3. To learn about the importance of imaging in the surveillance of patients with \nfatty liver disease. \nPanel discussion:  \nHow to optimise an imaging service for the obese patient?  \n09:44\n08:30 - 10:00 Room E2  \nFoundation Course: Breast Imaging  \nE³ 820c  \nMultidisciplinary team meeting  \nfrom Milan, IT  \nA-216 \nMultidisciplinary team meeting from Milan, IT  \nP. Panizza, R. Agresti, L. Lozza, G. Bianchi, B. Paolini; Milan/IT\n(pietro.panizza@istitutotumori.mi.it) \nThe concept of breast cancer units originates from the need for making \navailable to all women in Europe high-quality breast services where breast \ndisease could be looked after by specialists working as teams. Such teams \nhave to provide all the services related to breast cancer, including genetics and \nprevention, treatment of the primary tumour, care of advanced disease, \npalliation and follow-up of previously treated women. The breast unit is made \nup of a group of dedicated breast cancer specialists including a radiologist, \nradiographer, surgeon, reconstructive surgeon, pathologist, medical oncologist, \nradiation oncologist and breast care nurse . The specialists involved in breast \ncancer units have access to all the facilities required for high-quality care and \nspend most of their working time dealing with breast cancer. In our hospital, we \nroutinely work as a team and to make it possible we organise weekly meetings \ninvolving specialists from different disci plines to evaluate and plan patient care \nat any step of the diagnostic and therapeutic process. Each year, we take care \nof about 1.500 newly diagnosed patients with primary breast cancer and of \n10.000 patients in follow-up. About 500 are patients who undergo RT. After a \nshort introduction from our fellows from pathology, surgery, oncology and \nradiation therapy, who will discuss their role in the breast unit, we will try to give \na practical demonstration of the everyday work of breast units with particular \nemphasis on the role of the radiologist.  \nSession Objectives:\n1. To learn about breast cancer management. \n2. To understand when imaging is necessary for planning a therapeutic \nstrategy. \n3. To appreciate multidisciplinary team work. \n4. To become familiar with the various breast unit disciplines other than \nradiology. \n08:30 \nA. Radio-pathologic correlation/cooperation  \nB. Paolini; Milan/IT \nLearning Objectives:\n1. To understand how radiology can help in precancerous conditions. \n2. To consolidate knowledge on benign appearing masses which prove to be \nmalignant. \n3. To appreciate the pathologist's input at a multidisciplinary meeting. \n\nA B C D E F G S51  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n08:40 \nB. The surgeon's point of view  \nR. Agresti; Milan/IT \nLearning Objectives:\n1. To understand what the surgeon needs to know before operation. \n2. To learn how to ensure that postoperative images are understood. \n3. To appreciate the surgeon's input at a multidisciplinary meeting. \n08:50 \nC. Oncologist/radiotherapist's point of view  \nG. Bianchi, L. Lozza; Milan/IT \nLearning Objectives:\n1. To understand what the oncologist needs to know before starting treatment. \n2. To learn how to ensure that post-treatment images are understood. \n3. To appreciate the oncologist's input at a multidisciplinary meeting. \n09:00 \nD. MDT discussion  \nP. Panizza; Milan/IT \n08:30 - 10:00 Room F2  \nSpecial Focus Session  \nSF 8  \nImage-guided prostate biopsies: a \nparadigm shift  \nA-217 08:30 \nChairman's introduction  \nJ.C. Vilanova; Girona/ES (kvilanova@comg.cat) \nMR imaging has been playing an increasing role in the clinical management of \nprostate cancer. New MR techniques, multi-parametric (mp-MRI) acquisition, \nare showing improved assessment for prostate cancer detection and \ncharacterisation. The implementation of the new methodology on MRI needs to \nstandardise the use and establish the recommendations for the clinical \nindications, as it has recently been presented. Prostate cancer is usually \ndiagnosed with systematic blinded transre ctal ultrasound biopsies. However, \nthis method has low accuracy and for this purpose different approaches have \nbeen recently developed to change and improve the approach to diagnose \nprostate cancer. The challenge is to achieve an optimal and accurate method \nfor an imaging-guided prostate biopsy.  \nSession Objectives: \n1. To learn about the current role of imaging in managing prostate biopsy. \n2. To become familiar with the current recommendations and guidelines for \nmulti-parametric technique of prostate MRI and the standardisation of \nreporting. \n3. To learn about different approaches to improving the performance of \nprostate biopsy. \nA-218 08:35 \nMRI definition of the target: the ESUR scoring system  \nP. Zamecnik; Nijmegen/NL (Patrik.Zamecnik@radboudumc.nl) \nThe European Society of Urogenital Radiology (ESUR) published, in 2012, the \nnew clinical guidelines for evaluation of the multi-parametric MRI of the \nprostate. This structured reporting/scoring system (PI-RADS) is based on \nliterary evidence and consensus of experts' opinions. The PI-RADS scoring \nsystem is similar to that already employed by breast imaging (BI-RADS) and \nreflects the probability of a prostatic lesion to be significant. Each lesion can be \nscored in all sequences used in the multi-parametric prostate MRI protocols \n(T2- and diffusion weighted imaging, dynamic contrast enhanced imaging and \nMR spectroscopy) based on defined MRI criteria, which are specific for each \nsequence. Based on the scoring in the particular sequences a final PI-RADS \nscore for each lesion can be assessed. For each lesion a five-grade scoring \nsystems was created where, for example, the score 1 means that clinically \nsignificant disease is highly unlikel y to be present and score 5 clinically \nsignificant disease is highly likely to be present. This lecture elucidates the \nprinciples of this scoring system and its impact on the target definition for the \ninvasive diagnostics and therapy.  \nLearning Objectives:\n1. To show the value of standardisation of reading multi-parametric MRI using \n(PI-RADS). \n2. To learn how the PI-RADS reading should be done. \n3. To understand how localisation of PI-RADS 4 and 5 lesions can be used to \naim biopsy. \nA-219 08:53 \nA targeted-only biopsy strategy: impact on overdiagnosis and \novertreatment  \nN.B. Delongchamps; Paris/FR (nicolasbdl@hotmail.com) \nProstate cancer screening wi th PSA and exten ded systematic biopsy protocols \nhave led to the over-detection and over-treatment of small and well \ndifferentiated cancers, considered clinically insignificant. These cancers cover \nup to 70% of the overall prevalence and may not be of any threat. \nMultiparametric (mp)-MRI has shown recently its value in the detection, \nlocalisation and characterisation of prostatic tumour foci larger than 0.2 cm, \nand may be of value to address the issue of over-detection and over-treatment. \nAn MRI-targeted biopsy strategy alone, without any additional systematic \nbiopsies, has been suggested to decrease the detection rate of insignificant \ntumours while increasing that of potentially aggressive tumours. In patients \nwith no evidence of lesion on mp-MRI, the biopsy may probably be deferred. In \npatients with localised prostate cancer, mp-MRI may also become a \ncornerstone in the selection, guidance and surveillance of patients managed \nwith focal therapy. The rational for this new modality of treatment is to \ndecrease over-treatment by destroying exclusively the index lesion detected on \nmp-MRI. The precision of such treatments may be increased with MRI-\ntransrectal ultrasound image fusion, allowing  for real time navigation during the \nprocedure.  \nLearning Objectives:\n1. To consolidate knowledge of the clinical consequences of PSA screening \nand extended biopsy strategies. \n2. To understand and develop the scientific rational of targeted-only biopsy. \n3. To learn about the results of targeted-only biopsy. \n4. To learn about the implications for patient management and the selection of \nfocal therapy. \nAuthor Disclosure:\n N.B. Delongchamps: Speaker; LUT forum (Astellas), Janssen. \nA-220 09:11 \nMRI-guided biopsies: pros and cons  \nB. Hamm; Berlin/DE (bernd.hamm@charite.de) \nAllowing accurate detection of high-grade prostate cancer, multiparametric \nmagnetic resonance imaging (mp-MRI) techniques have expanded the role of \ntargeted biopsies of the prostate. MRI-guided prostate biopsy (MRGB) differs \nfrom systematic prostate sampling using transrectal ultrasound (TRUS) in that \ntissue can be specifically sampled from suspicious areas within the prostate. \nMR image guidance and targeting accuracy are the distinguishing features of \nMRGB compared with systematic (random) TRUS biopsies. Nevertheless, \nTRUS-guided biopsy is still the most widely used approach in patients with \nsuspected prostate cancer. With TRUS-guided biopsy, there is an association \nbetween the number of tissue cores obtained and the cancer detection rate. \nHowever, this association has its limits since some areas within the prostate \ncannot be sampled at all or are difficult  to reach with this biopsy technique. Mp-\nMRI, on the other hand, helps in the workup of suspicious prostate lesions by \nintegration of several techniques. These techniques range from cognitive \nfusion to direct MR-guided biopsy, which means that only targeted tissue \nsamples are obtained. The recent introduction of software-based fusion of MRI \ndatasets with real-time ultrasound images for prostate biopsy combines the \ndiagnostic accuracy of MRI with the wide availability of ultrasound-guided \nbiopsy.  \nLearning Objectives:\n1. To become familiar with the indications for MRI-guided biopsies. \n2. To learn about the technical approach. \n3. To learn about contraindications and complications. \n4. To understand future developments in biopsies guided by MRI/US fusion. \nAuthor Disclosure:\n B. Hamm: Board Member; Deutsche Röntgengesellschaft, European \nCongress of Radiology, European Society of Radiology, ESMRMB, European \nSchool of Radiology, Deutsche Forschungsgemeinschaft. Consultant; Bayer \nSchering Pharma, Toshiba. Grant Recipient; Kendle/ MorphoSys AG. \nA-221 09:29 \nTRUS-guided biopsies with TRUS-MRI image fusion: pros and cons  \nF. Cornud; Paris/FR (frcornud@imagerie-tourville.com) \nThe accuracy of multiparametric MRI has greatly improved the ability of \nlocalising tumour foci of prostate cancer. This property can be used to perform \na TRUS-MR image registration, a new technological advance, which allows for \nan overlay of an MRI onto a TRUS image to target a prostate biopsy towards a \nsuspicious area. Three types of registrations have been developed: cognitive-\nbased, sensor-based and organ-based registration. Cognitive registration \nconsists of aiming at a suspicious area during biopsy with the knowledge of the \nlesion location identified on multiparametric MRI. Sensor-based registration \nconsists of tracking in real time th e TRUS probe with a magnetic device, \n\nA B C D E F G S52  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nachieving a global positioni ng system which overlays in real time prostate \nimage on both modalities. Its main limitation is that it does not take into \naccount prostate and patient motion during biopsy Two systems (Artemis and \nUronav) have been developed to partially circumvent this drawback. Organ-\nbased registration (Koelis) does not aim at tracking the TRUS probe, but the \nprostate itself to compute in a 3D acquisition the TRUS prostate shape, \nallowing for a registration with the corresponding 3D MRI shape. This system is \nnot limited by prostate/patient motion and allows for a deformation of the organ \nduring registration. The pros and cons of each technique and the rationale for a \ntargeted-biopsy only policy are discussed.  \nLearning Objectives:\n1. To learn the physical principles of TRUS-MRI image registration. \n2. To become familiar with the different types of registration (cognitive, sensor-\nbased, organ-based). \n3. To learn about the accuracy of TRUS-MRI image registration-based prostate \nbiopsies. \n4. To understand the potential applications of TRUS-MRI image registration to \nguide focal therapy. \nPanel discussion:  \nAre we ready for the standardisation of MRI to manage prostate guided \nbiopsy in routine clinical practice?  \n09:47\n08:30 - 10:00 Room G/H  \nEFOMP Workshop  \nBetween diagnosis and therapy:  \nnew technology in imaging of the prostate  \nEF 1  \nImaging of the prostate for radiotherapy  \nModerators:  \nP. Sharp; Aberdeen/UK \nJ.N. Vassileva; Sofia/BG \nA-222 08:30 \nWelcome address  \nV.E. Sinitsyn1, P. Sharp2; 1Moscow/RU, 2Aberdeen/UK \nA-223 08:40 \nRadiologist point of view: clinical and technical requirements for imaging \nof the prostate  \nH.-P. Schlemmer; Heidelberg/DE (h.schlemmer@dkfz.de) \nProstate cancer is associated with high morbidity and accordingly high \nsocioeconomic impact. Due to overdiagnosis and overtreatment, avoidable \nmorbidity and costs are feared in a selective but unpredictable patient group. \nThe conventional way of establishing the diagnosis and making individual \ntreatment decisions relies on the indi vidual PSA serum le vel and pathologic \nGleason score from systematic TRUS biopsy samples, which has well-known \nlimitations. Patient stratification for c hoosing the best individual treatment \nbecomes increasingly challenging, as various less invasive treatment \nalternatives and active surveillance have  been established. Multiparametric MR \nimaging has been proven to be remarkably advantageous in this context for \ndetecting cancer, characterising its heterogeneity and aggressiveness, \ntargeting the most aggressive part (the dominant intraprostatic lesion, DIL), \nguiding the biopsy needle to that area and evaluation of local tumour \nspreading. The gained information supports individualised decision-making \nconcerning treatment selection, planning, guidance, monitoring and follow-up. \nIn case of active surveillance, functional MR parameters additionally yield \nobjective and reproducible biomarkers for monitoring temporal changes of \nindividual tumour aggressiveness during follow-up. PET imaging of prostate \ncancer with the use of various radiotracers is an ongoing research field applied \nin clinical studies. The recently developed novel PET/MR technology \nfurthermore opens the window to improved molecular diagnostics concerning \nbiologic cancer characterisation and detection of early cancer spread into \nlymph nodes and bone marrow. Multiparametric MR and PET/MR imaging will \nbe an important role for comprehensive assessment and staging of prostate \ncancer and thus for individualised patient management.  \nLearning Objectives:\n1. To become familiar with conventional diagnostic pathways and different \ntreatment options of prostate cancer. \n2. To appreciate the role of multiparametric MR and MR-targeted biopsy for \nclinical management of prostate cancer patients. \n3. To learn about novel developments of PET and PET/MR imaging for \nimproved diagnosis and (re-)staging of prostate cancer. \nAuthor Disclosure:\n H.-P. Schlemmer: Advisory Board; Siemens. Research/Grant Support; \nSiemens. Speaker; Siemens. \nA-224 09:10 \nUltrasound imaging in the treatment of prostate cancer  \nW.J. van der Putten; Galway/IE (wil.vanderputten@hse.ie) \nRadiotherapy of the prostate typically takes the form of either external beam \nradiotherapy or alternatively, brachytherapy  using radioactive seed implants. In \nboth cases, the use of ultrasound has been proven to be highly useful and this \npresentation will give an current state of the art overview of ultrasound in \nexternal beam and radioactive seed radiotherapy. In the case of external beam \nradiotherapy, accurate localisation of the prostate is essential to ensure \nadequate target coverage with minimal damage to normal tissue. Dedicated \nultrasound scanners are able to provide sub millimeter localisation of the \nprostate superior to the imaging traditionally obtained using CT scanners. This \npositional information can be obtained dai ly. In addition, ultrasound allows the \nimaging of patients with metal hip implants which are normally difficult to image \nusing CT. Apart from the benefits of the technique, some pitfalls will also be \nhighlighted. In the case of prostate brachytherapy, the use of ultrasound in the \n3-D volume imaging of the prostate both prior and during treatment will be \ndiscussed. In both cases, some time will be spend discussing the Quality \nAssurance requirements for ultrasound imaging systems.  \nLearning Objectives:\n1. To learn about the use of ultrasound in image guided radiotherapy. \n2. To understand the clinical capabilities of ultrasound guided radiotherapy. \n3. To understand and appreciate the limitations of the technology. \nA-225 09:35 \nCone beam computed tomography for treatment of prostate cancer  \nA. Torresin, B. Bortolato, M. Brambilla, C. Carbonini, P. Colombo, M. Minella, \nA. Monti, M. Parisotto, L. Trombetta; Milan/IT (alberto.torresin@unimi.it) \nImage-guided radiation therapy (IGRT) with onboard kilovoltage cone-beam \nCT (CBCT) allows image guidance during radiotherapy treatments for patient \nsetup and dose replanning. All these items will be discussed in connection with \nother topics: organ dose and image quality. It is compulsory to convert CBCT-\nimage's pixels from arbitrary grey scale to Hounsfield unit (HU). This \nconversion was obtained using a Catphan 600 phantom. The same phantom is \nused for image quality evaluation; standard CTDI head and body phantoms \nand a Farmer chamber were used to measure the CBDI to estimate organ and \neffective doses by Monte Carlo software of  different protocols of acquisition. \nCTDosimetry software (ver.1.0.4-ImPACT) and PCXMC2.0 Rotation software \nwere used. To verify the dose replanning techniques by CBCT, horizontal and \nvertical dose profiles were compared with the same obtained from CT. Patient \nreplanning was verified using CBCT vs CT in terms of conformity Index. Image \nquality parameters of CBCT (in comparison with CT images) are fine for spatial \nresolution, but are less useful for low contrast. CBDI of 5.7 mGy/100 mAs was \nmeasured; 4 mSv effective dose, 26 mGy prostate dose and 32 mGy bladder \ndose were evaluated and discussed during the presentation. Replanning on \ncylindrical phantom shows a mean percentage difference for each profile \u00012%\nand a variation on D mean in all inserts < 3%. The mean percentage difference \nbetween parameters characterising CT and CBCT-based plan values is less \nthan 5%. The replanning showed a substantial agreement with doses \nevaluated on the reference CT-image; patient dose must be evaluated for all \nradiation sources.  \nLearning Objectives:\n1. To learn about application of digital imaging in cancer treatment. \n2. To understand image quality and patient dose in CBCT. \n3. To appreciate the interdisciplinary approach of using CBCT in radiation \ntherapy. \n4. To become familiar with concept of image quality and patient dose in CBCT. \n5. To consolidate knowledge of rule of Medical Physics Expert for planning and \nverification in cancer treatment. \n\nA B C D E F G S53  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n08:30 - 10:00 Room I/K  \nHead and Neck Imaging  \nCC 819  \nHow to perform and read a head and neck \nstudy (part 1)  \nModerator:  \nJ. Olliff; Birmingham/UK \nA-226 08:30 \nA. Cranial nerve examination made easy  \nJ. Casselman; Bruges/BE (jan.casselman@azbrugge.be) \nCranial nerves I-VI have an anteroposterior course and are best examined in \nthe coronal plane. Cranial nerves VII-XII run in an anterolateral direction and \nare therefore best examined in the axial plane. These two planes also allow \nleft-right comparison which makes lesion detection easier. Lesions involving \nthe cranial nerve nuclei can be detected on axial proton-density/T2/multi-echo-\nGE images and diffusion-weighted images can exclude acute infarction. The \ncisternal segment of the cranial nerves is best detected on heavily T2-weighted \nimages (DRIVE/FIESTA/3D-TSE/CISS). At 3-tesla, 3D-sequences (e.g. b-FFE) \ncan be used and it is often possible to cover the cisternal segments of all 12 \ncranial nerves. In the cavernous sinus, the cranial nerves can only be \nevaluated on coronal gadolinium-enhanced high-resolution T1-weighted \nimages and similar axial images are needed to evaluate the nerves in the \njugular foramen and hypoglossal canal. Axial and coronal Gd-enhanced high-\nresolution T1-weighted with or without fat suppression are used to image the \nextracranial course of the cranial nerves. Today, the TSE-DIXON sequences \nprovide non-FatSat and FatSat images simultaneously, making cranial nerve \nimaging faster and easier. Time-of-flight images can be used to study \nneurovascular conflicts, although these can also be detected on submillimetric \nGd-enhanced T1 images. Of course, it is important to know the major anatomy \nof the cranial nerves and the most frequently occurring lesions. The above-\nmentioned imaging techniques, the most important anatomy and the most \nfrequently occurring lesions will be demonstrated and discussed in this lecture.  \nLearning Objectives:\n1. To learn how to perform an examination and evaluation of cranial nerves. \n2. To become familiar with some technical issues in obtaining good quality \nimages. \n3. To learn some basic information regarding cranial nerves anatomy. \nAuthor Disclosure:\n J. Casselman: Equipment Support Recipient; World reference site for MR \nequipment Philips. Speaker; Speaker at lunch sessions and meetings \norganised by Philips. \nA-227 09:00 \nB. MRI of the lower neck - feasible?  \nS. Gerevini; Milan/IT (gerevini.simonetta@hsr.it) \nMRI study of the lower neck space includes the study of anatomy and \npathologies of the thoracic outlet, or cervi cothoracobrachial junction, extending \nfrom the cervical spine and the mediastinum to the lower border of the \npectoralis minor muscle, the brachial plexus and the supraaortic vessels \n(carotid, subclavian arteries and veins). For this, use of a dedicated head and \nneck coil is fundamental to avoid frequent artefacts arising from air and the \npassage between different surfaces. Only in case of thoracic outlet evaluation, \na dynamic angio-MRI study should be performed and this means the use of a \nsurface coil. MRI protocol of the lower neck should include T1- and T2-\nweighted sequences. Both fat-saturated proton density and T2 with STIR \nsequences can be used to overcome the inhomogeneity of the magnetic field, \nespecially with large FOV. Sand bags can be placed on either side of the neck \nand suprascapular region of the patient to improve image quality. Also, flow \nsaturation bands can be utilised to limit blood flow artefacts. Also, volumetric \nsequences are in common use to obtain a quick examination. Breath or cardiac \ngating can be helpful. Abnormal findings of brachial plexus consist of nerve \nsignal abnormalities with mild or marked hyperintensity on T2-weighted, being \naware of magic angle effects and swelling. In case of thoracic outlet syndrome, \nMRI protocol should define the compression of brachial plexus components \narteries and or veins, both in indifferent and dynamic MRI acquisition.  \nLearning Objectives:\n1. To learn how to overcome difficulties in performing a lower neck study. \n2. To understand how to avoid the most common pitfalls. \n3. To become familiar with differential diagnosis. \nA-228 09:30 \nC. CT and MRI of temporal bone: user's guide  \nF. Veillon; Strasbourg/FR \nCT and MR imaging of the temporal bone must be performed with a precise \ntechnique. In CT it is important to locate the box of the study above and not in \nthe orbit to avoid the lenses. Irradiation is  divided by 10 compared with a study \nthrough the orbit. The axial sections must be parallel to the lateral semicircular \ncanal the coronal, sagittal sections are completed by oblique coronal views \nthrough the long process of the incus and the head of the malleus to get the \nossicular V. Double oblique sections through the 2 componants of the V permit \na view of the stapes and also the malleus and incus in 3 D (MIP : 3 mm). MRI \nmust be performed parallel to the roof of the orbit permiting very good axial \nsections in the plane of the lateral semic ircular canal (T1 and T2). The internal \nauditory meatus and the inner ear must be analysed with 1 mm axial sections \n(SE) after intravenous gadolinium injection completed by a high resolution T2 \n(gradient echo or SE) 0.3-0.4 MM, depending on the machine (3T, 1,5 T). The \nmiddle ear in chronic otitis media mu st be studied with T1, diffusion and high \nresolution T2. There is no need of contrast medium injection apart from the \ncomplication: fistula of the lateral semi circular canal, thrombosis of the sigmoid \nsinus. The different pathologies are then discussed: external auditory meatus \nand middle ear pathologies: CT first. MRI is useful for postoperative \ncholesteatomas. Inner ear malformations, otosclerosis, trauma: CT. \nLabyrinthitis, inner ear hemorragia, schwannomas, internal auditory canal \ncontent: MRI. \nLearning Objectives:\n1. To learn about acquisition protocols for temporal bone examination. \n2. To learn how to evaluate images and learn which post-processing tools to \nuse. \n3. To learn how to report on temporal bone findings. \n08:30 - 10:00 Room L/M  \nVascular  \nRC 815  \nImaging and intervention in acute \nischaemic stroke  \nModerator:  \nK.A. Hausegger; Klagenfurt/AT \nA-229 08:30 \nA. Acute stroke imaging  \nJ. Tacke; Passau/DE (josef.tacke@klinikum-passau.de) \nRevascularisation time windows for patients with acute ischemic stroke are \ngenerally restricted up to 4.5 hours in the anterior and up to 8 hours is the \nposterior perfusion area. Later treatment attempts require more accurate \nprediction of risk and benefit, as safety and efficacy at these time strata are \nless well. Thus, rapid and effective imaging is important for decision-making \nconcerning intrarterial catheter based recanalisation and/or thrombolytic \ntherapy. Advanced imaging techniques identi fy irreversible infarction as well as \ntissue at risk. Diffusion-weighted MRI de tects ischemia within minutes of onset, \nwhereas perfusion-weighted MRI and CT perfusion studies disclose the \nischemic penumbra. Combined, they provide information on mismatched \ntissue, i.e. potentially salvageable brai n. In addition, non-catheter angiographic \ntechniques like CT or MR angiography are a useful adjunct to localise arterial \nocclusion. As an attempt to a reliable emergency examination, the following \nprotocol has been proven to be robust: for the anterior perfusion area, a non \ncontrast CT may exclude cerebral bleeding and is followed by CT angiography \n(including supraaortic and intracranial vasculature). If technical available, CT \nperfusion should be performed in addition. In ischaemic strokes of the \nvertrebrobasilar region, CTA is essential  to exclude basilary stenoses or \nthrombotic occlusion. If the stroke onset remains unclear or might extend the \nabove mentioned time window, MR stroke imaging (i.e. diffusion, FLAIR and \nperfusion sequences) is suggested as MR offers a higher sensitivity. Anyway, \nthe best method for each emergency stroke imaging center is depending on \nclinical availability 24h/365 days, technical equipment and - finally - individual \nexperience of the emergency team.  \nLearning Objectives:\n1. To learn about parenchymal and vascular stroke imaging. \n2. To become familiar with appropriate imaging protocols for all imaging \nmodalities. \n3. To learn about the pros and cons of each modality. \n\nA B C D E F G S54  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-230 09:00 \nB. Indication for intervention  \nD. Vorwerk; Ingolstadt/DE (dierk.vorwerk@klinikum-ingolstadt.de) \nSome recent publications have questioned interventional treatment of stroke as \nan alternative to iv thrombolysis only. These papers - albeit published in high-\nranking sources - usually do not describe the modern concepts of \ninterventional stroke treatment. Interventional radiologists, therefore, are \nconvinced by their practical experience that the modern concept of combining \niv thrombolysis with mechanical thrombectomy by stent retrievers offers a \nbenefit to a subgroup of patients with severe stroke. This includes anatomical \nlevel of occlusion - basilar artery or single vertebral artery, proximal carotid \nocclusion with distal tandem occlusion, carotid T obstruction and M1 occlusion. \nM2 occlusions are debatable. Besides location, the clinical status of the patient \nbefore stroke and time of onset, absence of early CT signs of stroke or \nbleeding and clinical contraindicati ons to iv thrombolysis such as recent \nsurgery influence the decision-making. Mo re difficult than the description of \ntechnical success is prediction of clinical success. There are a couple of scores \nsuch as Thrive available that may be used for outcome forecasting. The \namount of collateral flow is frequently used as a decision tool, but is not always \neasy to quantify. Mismatch scores and penumbra have been questioned \nrecently. In conclusion, anatomical factors are pretty easy to identify to indicate \ntreatment, but the clinical and functional setting still lacks quick and reliable \nparameters that allow a clear decision-making, particulary in borderline cases.  \nLearning Objectives:\n1. To learn how to define the indication for treatment. \n2. To learn about the treatment decision-making process. \n3. To learn about the classification of lesions and indications for treatment. \nA-231 09:30 \nC. Mechanical revascularisation  \nA. Dörfler, T. Engelhorn; Erlangen/DE (arnd.doerfler@uk-erlangen.de) \nThe refresher course addresses the current state-of the-art use of different \nmechanical revascularisation strategies, devices and potential complications. \nIn addition, multimodal imaging applicati ons with a focus on patient selection \nfor endovascular recanalisation therapies, as well as new techniques to guide \nendovascular therapy within the angio suite are presented. Finally, some \norganisational aspects important for providi ng an interdisciplinary interventional \nstroke service are discussed. The ultimate goal of an acute endovascular \nstroke intervention is neurological recovery or improvement. Recanalisation of \nan arterial occlusion is key in achieving this goal. Clinical data suggest that \nendovascular stroke treatment results in higher recanalisation rates and may \nprovide superior clinical outcomes when compared with intravenous \nthrombolytic therapy only. However, these higher recanalisation rates are far \naway in being paralleled by equally higher rates of favourable outcomes in \nrecanalised patients. Thus, patient selection remains crucial. Besides the \ncareful neurological assessment, brain imaging is here of major importance. \nThe case presentations illustrate that imaging may help in patient selection for \nsubsequent thrombolytic/endovascular therapies by differentiation of patients \nwho may profit from intravenous or interventional therapy in an even extended \ntime window from those who do not. There are a number of key areas \nsupported by evidence-based medicine necessary for a high-level \ninterventional stroke service. As a pr econdition, a neurointerventional stroke \nservice has to be organised within a multidisciplinary acute stroke team. Inside \nthe hospital, it is all about streamlined pathways. Any possible delays should \nbe minimised at every step.  \nLearning Objectives:\n1. To learn the difference between mechanical and pharmacological stroke \ntreatment. \n2. To learn about different mechanical revascularisation techniques. \n3. To learn how to manage complications. \n08:30 - 10:00 Room N/O  \nInterventional Radiology  \nRC 809  \nPercutaneous treatment of chronic back \npain and sciatica  \nA-232 08:30 \nChairman's introduction  \nA. Gangi; Strasbourg/FR (gangi@unistra.fr) \nBack pain has a diverse etiology and causes pain, suffering and disability \nwhich have a great social and economic impact. Minimally invasive \npercutaneous techniques can improve the quality of life of well selected \npatients.  \nAuthor Disclosure:\n A. Gangi: Other; Proctoring Galil Medical. \nA-233 08:35 \nA. Sacroiliac joint syndrome  \nD.J. Wilson; Oxford/UK (david.wilson@ndorms.ox.ac.uk) \nSacroiliac joint pain may arise from a number of conditions including \ninflammatory arthritis, degeneration, fractures and tumours. Studies suggest a \nprevalence of 10% to 60% pain arising from  the joint in patients with positive \nclinical signs. Temporary effect is provided by a mixture of local anaesthetics \nwith steroids with a response varying between 50% and 80% in reported \nseries. Dual blocks using agents of differing duration are considered more \nprecise, but are less often used in practice. Imaging including MR and \nscintigraphy are of limited predictive value. Injections may be into the synovial \njoint, around the joint or adjacent to the nerve innervation of the joint. There is \nevidence that para-articular sources of pain are common and injection outside \nthe joint may be more effective. Sl-joint injections are performed through a \ndorsal approach guided by ultrasound, fluoroscopy or low-dose CT. Short-\nacting agents may have lasting benefit, but radiofrequency ablation has been \nemployed in an attempt to obtain long-term response. The evidence for lasting \ntherapeutic response to intra-articular or periarticular injection of steroids and \nconventional radiofrequency neurotomy is weak. There is fair evidence of long-\nterm response to cooled radiofrequency neurotomy.  \nLearning Objectives:\n1. To learn about relevant anatomy and clinical presentations of the syndrome. \n2. To learn more about the available treatments. \n3. To learn about clinical results and possible further developments. \nA-234 08:58 \nB. Facet joint syndrome  \nA.D. Kelekis; Athens/GR (akelekis@med.uoa.gr) \nFacet joints account for 25-40% of all low back pain. They are affected by \nosteoarthritis, joint space narrowing, intra -articular vacuum phenomenon/fluid, \nosteophytes, synovial cyst and ligament hypertrophy. Conservative therapy is \ninitially proposed. Percutaneous facet joint steroid infiltrations are minimally \ninvasive procedures involving injection of corticosteroid with or without local \nanaesthetic inside the joint. They also can  provide diagnostic verification of a \ncertain facet joint acting as the pain source. The injectate usually contains a \nlong-acting corticosteroid mixed with a local anaesthetic. Sodium hyaluronate \nsolutions or ozone were tested; however more and extensive studies are \nnecessary. Other options are either percutaneous ablation or surgical \narthrodesis. Fluoroscopy, computed tomography or magnetic resonance can \nbe used for guidance. Fluoroscopy has the advantage of real-time imaging. \nCone-beam CT can also be used. Computed tomography provides better \nanatomy information, but has increased radiation dose for the patient. \nMagnetic resonance has higher cost and longer duration. A recent study \nconcluded that it is twice the cost of CT-guided infiltrations. MRI can be used in \ncombination with focal ultrasound for ablation, a technique which is still under \ninvestigation. Success depends upon patient selection (59-94% immediate and \n27-54% long-term relief). The level of evidence is moderate for lumbar spine \nconcerning short- and long-term improvement. However, the most recent \nguidelines released (American Society of Pain Physicians) state that it is the \noldest and most commonly used technique. The success rates with its safety \nprofile and least invasiveness seem to make it an attractive therapy.  \nLearning Objectives:\n1. To understand the difference between facet joint and disc disease. \n2. To learn about different treatment options for facet disease. \n3. To learn how to manage patients. \nA-235 09:21 \nC. Intervertebral disc syndrome  \nN. Amoretti; Nice/FR (amorettinicolas@yahoo.fr) \nLow-back (LBP) is a frequent complaint and a leading cause of disability in the \ngeneral population. Epidemiological studi es have identified many individual, \npsychosocial, and occupational risk factors for its onset, but the primary \ncausative mechanisms of LBP remain largely undetermined. Psychological \nfactors have an important role in the transition from acute to chronic pain and \nrelated disability. A variety of minimally invasive techniques have been \ninvestigated over the years as treatment of back pain related to disc disease. \nBesides the classical surgical intervention, new therapeutic options have been \nproposed secondary to the progress in interventional imaging. Randomised \nclinical trials are important to assess treatments of painful conditions and low \nback pain. Due to the expected placebo effect and the subjective nature of pain \nassessment in general, the variable natu ral history of hernia and low back pain \noften responds to conservative care. After the commercial withdrawal of \nchymopapain, the need for new substances or devices to treat intervertebral \n\nA B C D E F G S55  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\ndisk hernias is important. The goal of this  communication is to give our point of \nview and experience in the treatment of symptomatic herniated disks by IR in \npatients in whom open surgery was indicated.  \nLearning Objectives:\n1. To understand possible treatment techniques for disc disease. \n2. To learn more about clinical and imaging findings in treatment. \n3. To learn about published results on percutaneous disc treatment. \nPanel discussion:  \nHow can imaging methods separate candidates for percutaneous therapy \nand surgery?  09:44\n08:30 - 10:00 Conf. Room M3  \nOncologic Imaging: Follow-up of Systemic and Local Therapies  \nCC 818  \nImaging after systemic therapies: \nadvanced techniques  \nModerator:  \nK. Brindle; Cambridge/UK \nA-236 08:30 \nA. What can we expect from biomarkers  \nB.E. Van Beers; Clichy/FR (bernard.van-beers@bjn.aphp.fr) \nBiomarkers are quantitative parameters measured with imaging methods that \ncan objectively assess disease status. A natomical imaging biomarkers based \non tumor size measurements (RECIST) are often used but have limitations \nbecause tumor size decrease may be delayed or absent. Therefore, \nmRECIST, EASL and Choi cri teria based on size measurements of viable, \ncontrast-enhancing tumor regions or on tumor attenuation are increasingly \nused for assessing the effect of targeted treatments. Moreover, there is a \ngrowing interest for validating functional imaging biomarkers such as perfusion \nand diffusion parameters obtained with ultrasound, CT and MR imaging. \nAlthough promising for early assessment of response to treatment, these \nnewer functional biomarkers need extensi ve validation and standardisation for \ntheir wide clinical use. Validation includes the assessment of reproducibility \nand accuracy, whereas standardisation concerns image acquisition and post-\nprocessing. The added value of the more complex functional biomarkers \nrelative to the viability parameters should also be shown. Viability and \nfunctional imaging biomarkers are evolving and emerging parameters for the \nearly assessment of response to treatment.  \nLearning Objectives:\n1. To become familiar with biomarkers. \n2. To consolidate knowledge of various biomarkers and their utility. \nA-237 09:00 \nB. MRI biomarkers: from acquisition to post-processing  \nO. Lucidarme, M. Wagner; Paris/FR (olivier.lucidarme@psl.ap-hop-paris.fr) \nMRI biomarkers must be able to show how tumours respond to specific \ntreatment. They need to allow assessment of the effectiveness of new \ntreatment more rapidly than classical clinical end points. These biomarkers \nmust be easy to obtain to facilitate a large spread of the technique. They have \nto be reproducible. The longest diameter of the tumour remains the easiest \nbiomarker that can be obtained from any kind of morphologic acquisition with \nno need of post-processing. Additional information about the tissular \norganisation and cellularity can be now easily obtained using modern scanners \nthrough diffusion-weighted sequences. The ease with which those sequences \nare obtained for a while masked the necessity to perform a more complex post-\nprocessing than the one initially done to get reliable biomarkers. There are \nnumerous MRI biomarkers of microcirculation, reflecting O\n2 consumption, \nblood volume, blood flow, vessel permeability and extravascular volume. To \nget them, we need more sophisticated acquisitions and image processing that \ntake into account the T1 of the tissue, arterial input function, respiratory motion, \netc. Most of these new MRI biomarkers are now used in research and in phase \nI studies, but have not been validated in more advanced clinical trials or in \nclinical practice. To use them widely and reliably, we need to perfectly \nunderstand the consequences of the choices we make during the acquisition \nand post-processing of these biomarkers.  \nLearning Objectives:\n1. To become familiar with MRI biomarkers. \n2. To learn some tips and tricks for MRI biomarker evaluation. \nAuthor Disclosure:\n O. Lucidarme: Board Member; Roche, Boehringer Ingelheim. Speaker; \nBracco. \nA-238 09:30 \nC. Assessing the precision and accuracy of biomarker imaging: is it \nreproducible?  \nD.-M. Koh; Sutton/UK \nNew targeted treatments in cancer can be effective without significantly \nreducing tumour size. There are already a large number of targeted treatments \nthat are licensed to treat a range of cancers. For some of these cancers, there \nis currently no reliable method to tell whether the drug is effective and new \nresponse, predictive and prognostic biomarkers are required. Functional \nimaging techniques such as diffusion-weighted MRI, dynamic contrast-\nenhanced MRI and FDG-PET imaging are being developed or applied as \nresponse biomarkers. However, for these to be useful in a wider multi-centre \nsetting, the measurements need to be precise, repeatable and reproducible. \nWe discuss these properties in the context of emerging imaging response \nbiomarkers.  \nLearning Objectives:\n1. To understand imaging biomarker precision (repeatability and \nreproducibility) and accuracy and how it is evaluated. \n2. To learn how to interpret biomarker precision and accuracy in the context of \nthe biomarker's intended use. \n08:30 - 10:00 Board Room A \nCardiac  \nRC 803  \nQuantification of myocardial perfusion: \nwhich test is the best (PET, MRI, MDCT)?  \nModerator:  \nA. Jacquier; Marseille/FR \nA-239 08:30 \nA. PET for evaluation of perfusion, absolute myocardial blood flow and \ncoronary flow reserve  \nJ. Bucerius; Maastricht/NL (jan.bucerius@mumc.nl) \nCoronary artery disease (CAD) and its related cardiac disorders are still the \nnumber one cause of death in the USA and the Western world. Up to date, \nsingle photon computed tomography (SPECT) using traditional radiotracers \nlike thallium-201 or Tc-99m sestamibi is the most utilised imaging technique for \nthe assessment of myocardial perfusion. However, over the past decade, there \nhas been a growing interest in cardiac imaging with positron emission \ntomography (PET) and, indeed, a paradigm shift has been witnessed in the \nuse of myocardial perfusion imaging (MPI) with PET taking advantage of the \nsuperior imaging properties of PET over SPECT. Therefore, PET MPI is now \nbeing increasingly used for routine clinical evaluation of patients with known or \nsuspected CAD. Furthermore, it is being used not only at large academic \ninstitutions, but also at community hospitals and even in private practice. \nSeveral factors contribute to this shift in the use of PET MPI, including the \ngrowing availability of combined PET and computed tomography (CT) systems, \nmainly driven by oncological applications, radiotracer, like rubidium-82 or 18 F-\nflurpiridaz, which can be used in clinical routine, changes in reimbursement, \nand the increasing clinical evidence supporting the value of PET/CT MPI. The \nlecture \"PET for evaluation of perfusion, absolute myocardial blood flow and \ncoronary flow reserve\" will cover several aspects of the growing field of PET \nMPI.  \nLearning Objectives:\n1. To understand the molecular tracers used to asses myocardial perfusion by \nPET. \n2. To appreciate the strengths and limitations of PET in evaluating of \nmyocardial perfusion. \n3. To become familiar with its role in different clinical scenarios. \n\nA B C D E F G S56  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-240 09:00 \nB. Stress perfusion CT imaging for the detection and quantification of \nrelevant coronary stenosis  \nF. Bamberg; Munich/DE (fabian.bamberg@med.uni-muenchen.de) \nBesides the visualisation of coronary morphology, computed tomography (CT) \nhas shown feasibility to also assess myocardial perfusion. Currently, there are \ntwo different approaches to CT-based myocardial perfusion imaging: single-\nshot and dynamic, sequential acquisitions over a predefined scan time. The \npresentation will cover basic concepts of both approaches and highlight \nprotocol details and findings in these stress acquisitions. Also, emerging \nscientific results with respect to diagnostic accuracy, the detection of \nhemodynamically relevant coronary stenosis and prognostic implications will \nbe discussed.  \nLearning Objectives:\n1. To learn about protocol setup and interpretation of stress myocardial \nperfusion CT. \n2. To understand the prognostic implications and therapeutic considerations of \nCT perfusion parameters. \n3. To appreciate the value of stress myocardial perfusion CT for the detection \nof significant coronary stenosis. \nAuthor Disclosure:\n F. Bamberg: Research/Grant Support; Bayer Healthcare. Speaker; Bayer \nHealthcare, Siemens Healthcare. \nA-241 09:30 \nC. Analysis of myocardial perfusion using MRI  \nR. Manka; Zurich/CH (robert.manka@usz.ch) \nOver the past few years, cardiovascular magnetic resonance imaging (CMR) \nhas been increasingly established as an important method in the diagnosis of \ncardiovascular disease. Many studies have shown the equality or even \nsuperiority of CMR compared to other imaging modalities (e.g. nuclear \nmedicine and echocardiography). CMR offers important advantages like the \nabsence of ionising radiation, high spatial  resolution, and the combination of \nperfusion imaging with tissue characterisation. The main clinical applications in \nthe assessment of coronary artery disease (CAD) include ventricular function, \nmyocardial viability and perfusion. In clinical routine, myocardial perfusion is \ndetermined by contrast-enhanced first-pass perfusion techniques during \npharmacological stress using coronary vasodilators (e.g. adenosine) or ß-\nadrenergic agents (e.g. dobutamine). Non-invasive characterisation of \nmyocardial microcirculation is thought to reflect myocardial tissue supply much \nbetter than mere luminographic detection and quantification of epicardial \ncoronary stenosis, and has been shown to be useful for planning of \nrevascularisation procedures and cardiac risk stratification. In several studies \non the prognostic value of CMR in CAD assessment, normal stress perfusion \nCMR was highly predictive for a good prognosis, thus able to identify patients \nin whom invasive angiography can be deferred safely.  \nLearning Objectives:\n1. To learn about protocol setup and interpretation of stress myocardial \nperfusion CT. \n2. To understand the role of CMR perfusion imaging as a tool for diagnosis and \nprognosis of coronary artery disease. \n3. To discuss how CMR perfusion can be utilised in the assessment of \nmicrovascular disease. \n08:30 - 10:00 Room P  \nJoint Session of the ESR and ESMRMB  \nDiffusion MRI: everything you always \nwanted to know but never dared to ask  \nModerators:  \nE.-M.B. Larsson; Uppsala/SE \nM. Smits; Rotterdam/NL \nA-242 08:30 \nDiffusion MRI: the bare basics  \nC.A.M. Wheeler-Kingshott; London/UK (c.wheeler-kingshott@ucl.ac.uk) \nThe purpose of this lecture is to demonstrate how it is possible to sensitise the \nMR signal to water molecules diffusi on in tissue and how to use calculated \nindices to reflect structural integrity . The concept of diffusion-weighted imaging \nwill be introduced with particular emphasis on the pulsed gradient spin echo \n(PGSE) sequence. Methods to calculate the apparent diffusion coefficient \n(ADC) will be described and the concept of the diffusion tensor (DT) will be \nexplained. Image processing of diffusion data includes steps like eddy current \ndistortion correction, model fitting an d potentially registration of maps to a \nreference space. Indices that are reproducible and rotationally invariant will be \ndescribed, such as fractional anisotropy (F A), mean diffusivity (MD), axial \ndiffusivity (AD) and radial  diffusivity (RD). Examples of when to use the ADC \nmaps or the DT indices will be given in relation to pathologies such as stroke, \nmultiple sclerosis and neurodegenerative diseases. Strategies for result \npresentation such as region of interest approach, histogram analysis and tract-\nbased methods will be shown. Limitations and advantages of diffusion imaging \nmethods such as DT do not preclude the use of this technique in research and \nclinical radiology for investigating structural changes in disease.  \nLearning Objectives:\n1. To understand the basic principles of diffusion MRI (diffusion-weighted \nimaging, diffusion tensor imaging). \n2. To learn how to select an optimal diffusion-weighted imaging protocol for \nclinical neuro and body imaging. \nAuthor Disclosure:\n C.A.M. Wheeler-Kingshott: Advisory Board; Biogen (BG12). Author; \nPublications in Peered Reviewed Journals. Employee; University College \nLondon. Research/Grant Support; Multiple Sclerosis Society of great britain \nand Northern Ireland, Biogen, Novartis, Medical Research Council, \nEngineering and Physical Sciences Research Council, International Spinal \nResearch TrustInternational Society. S peaker; Invited speaker at national and \ninternational conferences and iniversities. \nA-243 08:50 \nProcessing and analysing diffusion MRI data  \nW. Van Hecke; Antwerp/BE (wim.vanhecke@ua.ac.be) \nDiffusion imaging methods have a lot of potential to be used in clinical practice. \nHowever, although diffusion-weighted im aging has been increasingly applied, \nclinical use of diffusion tensor imaging is limited to date. This is in part due to \nthe lack of standardisation and the need for more complex analysis tools to \nevaluate the data. During this lecture, an overview will be provided of some \nanalysis methods for diffusion-weighted and tensor imaging. I will discuss the \ndifferent parameters that can be obtained as well as some advantages and \nlimitations of the different analysis methods.  \nLearning Objectives:\n1. To learn about post-processing of diffusion-weighted imaging and the \nterminology for diffusion parameters. \n2. To learn about qualitative analysis of diffusion-weighted images including T2 \nshine-through. \n3. To learn about quantitative measurements of diffusion parameters in clinical \nradiology. \n4. To understand different possibilities for analysing diffusion tensor imaging in \nclinical radiology. \nAuthor Disclosure:\n W. Van Hecke: Founder; icoMetrix. \nA-244 09:10 \nClinical applications of diffusion MRI (neuro)  \nE.-M.B. Larsson; Uppsala/SE (elna-marie.larsson@radiol.uu.se) \nIt is highly recommended to include diffusion-weighted imaging (DWI) in the \nroutine protocols for MRI of the brain. DWI as well as automatically calculated \napparent diffusion coefficient (ADC ) map is used for evaluation. The ADC \nvalues of gray and white matter are iden tical in the adult brain. Restricted \ndiffusion (high signal on DWI and low signal on ADC) is seen not only in acute \nstroke, but can also be present in some brain tumours, the necrotic centre of \nabscesses, some acute MR plaques, some contusions, encephalitis, \nCreutzfeldt-Jakob disease, metabolic di seases, etc. This finding is thus not \nspecific, but is very helpful combined with  clinical information and the signal \npattern on other sequences. Acute stroke has restricted diffusion during the \nfirst 7-10 days and the diffusion gradually increases to become very high in a \nchronic infarct. The diffusion changes in ischemic brain and sp inal cord tissue \nare usually irreversible, but may be reversible. Brain tumours with high \ncellularity, such as lymphoma, glioblastoma multiforme, medulloblastoma and \nmetastases from small cell lung carcinoma, usually have restricted diffusion. \nThe surrounding vasogenic oedema has increased diffusion. In the central \nnecrosis of a pyogenic abscess the diffusion is restricted, while it is increased \nin the necrotic centre of a malignant brain tumour. Reversible diffusion \nrestriction in the cortex, the hippocampi and thalami can be seen in patients \nwith status epilepticus. Diffusion tensor imaging has so far had limited clinical \nuse, but may be useful, e.g. for the preoperative evaluation of brain tumours.  \nLearning Objectives:\n1. To understand the differential diagnostic possibilities of high signal intensity \nlesions on diffusion weighted images (DWI) of the brain and spinal cord. \n2. To become familiar with the appearance of acute, subacute and chronic \nstroke on DWI. \n3. To learn about the appearance of cerebral tumours, infection/inflammation, \nneurodegenerative diseases and traumatic lesions on DWI. \n4. To understand the present use of diffusion tensor imaging (DTI) and \ndiffusion tensor tractography (DTT) in clinical neuroradiology. \n\nA B C D E F G S57  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-245 09:30 \nClinical applications of diffusion MRI (body)  \nH. Ahlström; Uppsala/SE (hakan.ahlstrom@akademiska.se) \nThe signal intensity in diffusion-weighted imaging (DWI) reflects the cell density \nin the tissue. DWI, including apparent  diffusion coefficient (ADC) maps, can \ntherefore be used to differentiate highly cellular from acellular regions of \ntumours, distinguish cystic from solid le sions, and monitor change in tumour \ncellularity over time, reflecting response to therapy. In general, tumours have \nhigh signal intensities in DWI, but low corresponding ADC values compared to \nnormal/benign/reactive tissues. DWI has a wide range of clinical applications, \nwhich includes cancer imaging, imaging of infections and inflammations, \nevaluation of trauma and visualisation of peripheral nerves. Of these, the most \npromising application appears to be in oncological imaging. There is, e.g. now \nevidence to recommend inclusion of DWI in MRI protocols for lesion detection \nand characterisation in the liver. The advent of whole body (WB) MRI including \nWB-DWI (from root of the neck to groin) has introduced tumour imaging with a \nsystemic approach compared to established multi-modal diagnostic algorithms. \nIt has been found valuable for staging, therapy evaluation and surveillance of \ntumours, especially in children. However, DWI is generally recommended to be \nincorporated into oncologic MRI protocols of both WB-MRI and of selected \norgans, because it provides additional valuable information to the conventional \nMR sequences. DWI of the body is frequently prone to imaging artefacts, which \ncan obscure or mimic lesions. To minimise misinterpretations, analysis of the \nraw b-value images directly in conjunction with ADC maps and conventional \ncoregistered sequences is recommended.  \nLearning Objectives:\n1. To understand the present indications for whole-body DWI and DWI of \nselected organs of the body. \n2. To learn how to interpret whole-body DWI qualitatively and quantitatively, \nincluding tricks and pitfalls. \n3. To learn about the oncologic applications of DWI in the body. \n4. To learn about the appearance of other diseases of the body on DWI. \nAuthor Disclosure:\n H. Ahlström: Research/Grant Support; Astrazeneca. \nPanel discussion  \n09:50\n10:30 - 12:00 Room A  \nInteractive Teaching Session  \nE³ 920a  \nThe treated spine and joints  \nA-246 10:30 \nA. Imaging of the postoperative spine  \nP.N.M. Tyrrell; Oswestry/UK (prudencia.tyrrell@rjah.nhs.uk) \nSpinal surgery is most frequently performed to decompress (disc herniation, \nstenosis, malignant infiltration), fuse and stabilise (particularly following trauma \nor infiltrative destructive processes) and correct deformity. Often, there may be \na combination of these procedures at one operation. Surgical instrumentation \nor bone graft is sometimes employed. Patients may present themselves with \nsymptoms early or late following the procedure. This interactive session seeks \nto address the variety of surgical procedures undertaken and subsequently \nimaged post-operatively because of symptoms. The session aims to help one \nto understand and become familiar with the expected post-operative imaging \nappearances related to the surgical procedure, learn about abnormal \npathological features as a cause of symptoms in the acute and more chronic \nsituation and explore the diagnosis and differ ential diagnosis. This may include \npost-operative fibrosis versus recurrent disc herniation versus post-operative \ninfection. Failure of fusion due to failure of instrumentation or inadequate take \nof bone graft can give rise to pseudoarthrosis. Recurrent stenotic symptoms \nmay relate to an inadequate decompression, recurrent disc herniation, post-\noperative haematoma, extension of a malignant process or ischaemic damage.  \nLearning Objectives:\n1. To understand changes related to surgery. \n2. To learn about changes related to non-surgical treatments. \nA-247 11:15 \nB. Imaging of joint replacement  \nM. Zanetti; Zurich/CH (marco.zanetti@hirslanden.ch) \nJoint replacement surgery for the treatment of arthritis most often offers the \npatient excellent results. However, there are potential complications that a \nradiologist should know about. It is essential to understand the importance of \npre- and postoperative imaging for evaluating patients. Most commonly, \nstandard radiographs are used to assess the patients after joint replacement. \nHowever, CT, nuclear medicine methods as well as MR imaging play an \nincreasing role in such patients. The radiologist should be aware of the most \ncommon type of prosthesis and the most common complications after joint \nreplacement. These complications include postoperative prosthesis loosening, \nprosthesis fractures, periprosthetic fractures, postoperative infection, rotation \nfailure of the prosthesis, and soft ti ssue abnormalities such as surrounding \ntendon tears. This interactive session seeks to address the variety of joint \nreplacements which are undertaken and subsequently imaged postoperatively \nas a result of symptoms. The session aims to help one to understand and \nbecome familiar with the expected postoperative imaging appearances related \nto joint replacement, learn about abnormal pathological features as a cause of \nsymptoms and explore the diagnosis and differential diagnosis.  \nLearning Objectives:\n1. To learn about changes related to surgery. \n2. To understand changes related to non-surgical treatments. \n10:30 - 12:00 Room B  \nESR meets Serbia  \nEM 2\nA guided tour of radiology in Serbia  \nWelcome by the ESR President  \nG. Frija; Paris/FR \nPresiding:  \nM.A. Lucic; Sremska Kamenica/RS \nV.E. Sinitsyn; Moscow/RU \nA-248 10:30 \nIntroduction  \nM.A. Lucic; Sremska Kamenica/RS (milos.a.lucic@gmail.com) \nSerbia is a beautiful country where East and West merged and often collided \nfor centuries, and where nowadays Eastern cultural heritage meets and mixes \nwith the Western heritage in a lovely and unprecedented way, with a lot of \ncharm and with a variety of extraordinarily natural beauty and plenty of both \ntraditional and gastronomical wonders to explore. It extends from the edges of \nthe Pannonian flatland in the north, over the Danube and Sava rivers to the \ngradually growing wonderful mountains in the south. Already in 1897, the first \nX-ray unit was installed, and only twenty years later X-ray units are present in \nmost state-owned and private hospitals in Serbia. Nowadays, slightly more \nthan half of the thousand radiologists in Serbia perform a broad variety of \ndiagnostic imaging and interventional tech niques in different radiological units, \nincluding numerous CT, MRI, and few PET/CT units distributed in five \nuniversity centers, a number of public clin ical centers and hospitals, and also in \nthe private sector. Several centers are fully equipped with PACS and RIS \nsystems, and are capable of performing teleradiology services. There are still \nsignificant challenges in Serbian ra diology in the field of education and \nresearch, planning and implementation of national radiology networks, \nimprovement of standard clinical practice and financing the new equipment. \nYet since radiologists' enthusiasm overwhelms most of the difficulties, \nradiology in Serbia provides nowadays a broad variety of modern and \ncompetent diagnostic and interventional procedures, improving the \nmanagement and treatment of our patients.  \nSession Objectives: \n1. To get a brief insight into the variety of radiological techniques in Serbia \ntoday. \n2. To learn about interventional radiological techniques in the therapy of \nvaricoceles. \n3. To understand the potential of MRI in the diagnosis of non-ischaemic \ncardiomyopathies. \n4. To appreciate the concept and importance of foetal MRI in the early \ndetection of CNS abnormalities. \nA-249 10:35 \nInterventional treatment of varicoceles  \nP.M. Bosnjakovic, Z. Radovanovic, D.A. Stojanov, A. Bojanovic; Nis/RS\nVaricoceles are considered to be one of the most frequent causes of male \ninfertility. The entity represents the insufficiency of the spermatic vein, which by \nan unknown mechanism causes inefficient spermatogenesis. A variety of \ntechniques for spermatic vein occlusion have been described since 1966, \nwhen the first interventional treatment took place. We aim to describe and \nreview the variety of techniques used by the authors and evaluate our own \nexperiences with more than 2000 treated patients. In 30 years, more than 2000 \npatients have been treated. The methods have been changing over time taking \ninto consideration developments in interventional tools and experiences of \nother authors. Successful catheterization was achieved in almost all of the \npatients. Most frequently, the so-called \"sandwich technique\" was used \n\nA B C D E F G S58  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nconsidering the embolic device at the level of the inguinal ligament, then \nsclerotic agent followed by another embolic device more proximally. Using this \ntechnique it is possible to protect the pampiniform plexus and obliterate all the \ncollateral veins and parallel anastomosis. Gelfoam plugs were used in the vast \nmajority of patients and pushable or detachable coils only when there was a \ntechnical demand (large vein, difficult di stal positioning of the catheter). \nAetoxisclerol was the most frequently use d sclerosant. Initial vein occlusion \nwas achieved in all patients. Two puncture site complications occurred. In one \npatient, the tip of the catheter broke and was flown to the right middle \npulmonary artery branch and subsequently percutaneously extracted without \nclinical consequences. The reccurence rate was within literature limits. The \npercutaneous treatment of varicoceles has been proven to be safe and \nefficient.  \nLearning Objectives:\n1. To learn about the different radiological techniques for spermatic vein \nocclusion during the last 50 years. \n2. To understand radiological treatment compared to other treatment options. \n3. To appreciate the importance of varicoceles. \nA-250 10:55 \nInterlude: Radiology in Serbia at a glance  \nT. Stosic-Opincal; Belgrade/RS (topincal@gmail.com) \nRadiology in Serbia, since its beginning, has been inextricably linked to \nEuropean radiology. There are written documents testifying to the fact that the \nfirst x-ray appliances in Serbia had emerged and had been used for medical \npurposes only two years after Wilhelm Conrad Röntgen discovered x-rays in \n1895. The real beginnings of diagnostic radiology in Serbia can be linked to the \nestablishment of the General State Hospital in 1908, where the first x-ray \ncabinet was installed. Later discoveries in  the field of radiological techniques, \nmaterials and contrast agents were also immediately accepted by the Serbian \nradiology community. The first cerebral angiography was performed in 1935, \nwhich may be considered as the beginning of neuroradiology in Serbia. The \nsecond half of the twentieth century is characterised by the introduction and \nwide application of ultrasound, CT and MR diagnostics and outbreak of \nvascular and nonvascular interventional radiology procedures in the areas of \nneuroradiology, uroradiology, and cardiovascular and gastrointestinal \nradiology. For years, Serbian interventional radiology has successfully kept \npace with achievements of the most relevant centres worldwide. Nowadays, \nSerbian radiologists monitor and enforce the most complex modern procedures \nin different areas of radiology. The rapid development of science and \ninformation technology has enabled the daily monitoring of all modern \ndevelopments, methods and approaches and their increasingly faster \nintroduction into practice.  \nA-251 11:00 \nMRI in non-ischaemic cardiomyopathies  \nR. Maksimovi\u0005; Belgrade/RS (ruzica.maksimovic@med.bg.ac.rs) \nNon-ischaemic cardiomyopathies (NICM) refer to myocardial diseases caused \nby mechanical and/or electrical disord er in the absence of significant coronary \nartery disease, valvular heart disease, hypertension, or congenital heart \ndisease. NICM often present with geneti c mutations, but no clinically apparent \ndisease. In some cases, the presence of fibrotic tissue could cause adverse \nevents and, therefore, the use of late enhancement (LE) post-gadolinium \ntechnique is necessary in evaluating these patients. LE suggestive of fibrotic \ntissue could be found in up to 35% of patients with NICM. In the majority of \ncases (up to 65%), midwall/subepicardial enhancement could be found; patchy \nenhancement, often at septal junctions, has been registered in 35% of patients, \nwhile the least common pattern of LE was subendocardial (5%). In ischaemic \ncardiomyopathy (ICM), subendocardial or transmural is a typical pattern of \nhyperenhancement and is related to coronary artery distribution. Furthermore, \nLE has the potential to provide important information for risk stratification in \nclinical practice. In NICM, the extent of fibrosis has been shown to be \nindependently associated with increased rates of future adverse events \nincluding all-cause mortality, while in ICM myocardium with LE in more than \n50% of wall thickness is unlikely to re cover contractile function following \ncoronary revascularisation. As many NICM disorders are associated with the \npresence of scar tissue, LE in NICM is nonspecific and should be correlated \nwith clinical presentation and history, wh ich is critical in the evaluation of these \npatients.  \nLearning Objectives:\n1. To learn how to differentiate non-ischaemic and ischaemic \ncardiomyopathies. \n2. To understand and describe patterns of delayed enhancement in non-\nischaemic cardiomyopathies and their prognostic value. \n3. To learn how to develop an accurate differential diagnosis of non-ischaemic \ncardiomyopathies based on MRI features. \nA-252 11:20 \nInterlude: Hop-on, hop-off sightseeing tour of Serbia  \nS. Stojanovic; Novi Sad/RS (tupsons@gmail.com) \nIn the interlude between scientific lectures, you are most welcome to hop on a \nsightseeing tour around Serbia during which we shall stop at a few stations \nwhere the natural and cultural heritage of our country will be shown. Nota \nbene: some of the sights will be visible to everyone and some only to \nradiologists. Ten thousand years of human effort and five billion years of \nEuropean soil refinement will blink in front of your eyes through the window we \nhave made with red churches' walls, azure skies and a silver sparkle of our \nspirit. All the time, a bit of grayscale sh adow will supplement the picture as we \nin radiology are so used to. Fragments of past and present will make a mosaic, \nthe glance of which will hopefully light up your day. When you hop off our tour, \nwe believe, some pictures will become part of your emotional memory and \nmaybe will make you wish to see them in vivo.  \nA-253 11:25 \nThe role of prenatal MRI in foetal central nervous system abnormalities: a \ncase-based pictorial review  \nK. Koprivsek; Sremska Kamenica/RS (katarina.koprivsek@gmail.com) \nMRI provides a unique opportunity for studying in vivo central nervous system \ndevelopment. Its higher contrast resolution compared with prenatal sonography \nallows better visualisation of sonographically occult normal CNS structures as \nwell as structural abnormalities. In clinical praxis, prenatal MRI has become a \nmandatory tool in evaluating: a) foetuses that have abnormalities suspected on \nthe basis of foetal sonography; b) foetuses with increased risk for brain \nabnormalities even in the setting of a normal prenatal sonogram (family history \nof CNS anomalies or a genetic/metabolic disorder); c) foetuses potentially at \nrisk due to maternal illness; d) foetuses with congenital malformation, which \nare candidates for prenatal or neonatal surgical treatment; e) foetuses that \ncould not be evaluated by sonography due to oligohydroamnion, maternal \nobesity, difficult position of the foet al head, or US reverberation on foetal \ncalvaria in advanced gestational age. We will present a selection of foetal CNS \nabnormalities detected in our Institution during the last 8 years, including \nventriculomegaly, abnormalities of the posterior fossa, agenesis of the corpus \ncallosum, cerebral cortex developmental abnormalities, spine developmental \nabnormalities and a variety of encephaloclastic lesions. In all previously listed \ncases, prenatal MRI could provide either crucial or additional information, \nwhich can lead to the accurate diagnosis of different CNS developmental \nabnormalities (cortical, commissural and posterior fossa malformation), specific \ndisorder or syndrome, further enabling adequate pregnancy management and \nparents' counselling.  \nLearning Objectives:\n1. To learn about normal anatomical findings and sequences used. \n2. To know when, why and how to perform a prenatal CNS MRI study and what \nto look for. \n3. To learn how to confirm the presence of foetal CNS pathology, define its full \nextent, characterise it and demonstrate associated abnormalities using \nprenatal MRI. \n4. To learn about a selection of relevant cases from our institution, including \nventriculomegaly, abnormalities of the posterior fossa, agenesis of the corpus \ncallosum, cerebral cortex developmental abnormalities, spine developmental \nabnormalities and a variety of encefaloclastic lesions. \n5. To assess the potential of prenatal MRI in parent counselling, management \nof pregnancy and delivery, and postnatal care planning. \nPanel discussion:  \nRadiology in Serbia: frequently asked questions  \n11:45\n10:30 - 12:00 Room E2  \nFoundation Course: Breast Imaging  \nE³ 920b  \nHow to report  \nModerator:  \nR. Holland; Nijmegen/NL \nA-254 10:30 \nA. Mammography  \nF.J. Gilbert; Cambridge/UK (fjg28@cam.ac.uk) \nThis lecture will cover the standard mammographic views required, the \nreporting systems for mammograms together with BIRADS and other \nEuropean systems, breast density, feature analysis, information the clinician \nrequires in a cancer case and how to approach a B3 lesion. ACR Practice \nguidelines (2008) recommend obtaining previous mammograms as you can \n\nA B C D E F G S59  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\ndismiss an abnormality that is unchanged for 5 years or that has been \npreviously worked up and are able to detect subtle new lesions more easily, \nalthough this has not been confirmed in the screening situation. In a structured \nreport the following information is recommended: indication, breast density, \ndescription of lesion, size, location, comparison to previous findings, overall \nassessment, management recommendations and a score to indicate the level \nof suspicion. Examples of different common conditions seen on mammography \nwill be shown including soft tissue masses, microcalcification, architectural \ndistortion and asymmetry.  \nLearning Objectives:\n1. To become familiar with BI-RADS mammography descriptors and \nassessment categories. \n2. To understand which information a clinician needs to find in a breast cancer \npatient's report. \n3. To learn about the basic parts of a structured report, specifically in BI-RADS \n3 lesions. \nAuthor Disclosure:\n F.J. Gilbert: Speaker; Bracco. \nA-255 11:00 \nB. Breast US  \nJ. Camps Herrero; Valencia/ES (juliacamps@gmail.com) \nBreast ultrasound is one of the main imaging modalities in breast radiology, it \nallows us to characterise lesions and also guide interventional procedures. The \nBI-RADS categorisation of ultrasonographic findings facilitates the diagnostic \napproach and also helps the radiologist to use a common language, \nunderstood not only by the rest of the radiological community, but also by other \nbreast cancer professionals. Ultrasound can be a diagnostic procedure on its \nown, but is mainly a modality that characterises the findings of other modalities \n(mammography and MRI) and, as such, correlation between all these \ntechniques is the mainstay of everyday clin ical practice. This act of correlating \nand integrating the information of all modalities is what makes a breast \nradiologist a key actor in the diagnosis, staging and follow-up of breast cancer \nand other benign or high-risk entities. The final product of this integration will \nbe the radiological report, the means by which we convey all the information \nwe have gathered through all the procedures to our clinical colleagues. This \nreport shall also follow some composition rules to be clear and concise.  \nLearning Objectives:\n1. To become familiar with BI-RADS US descriptors and assessment \ncategories. \n2. To learn how to integrate clinical information into radiological findings. \n3. To learn how to write a breast US report in a cancer patient. \nAuthor Disclosure:\n J. Camps Herrero: Advisory Board; Bayer. Speaker; Bayer. \nA-256 11:30 \nC. MRI of the breast  \nM.H. Fuchsjäger; Graz/AT (michael.fuchsjaeger@medunigraz.at) \nAs with any other modalities, breast magnetic resonance imaging (MRI) \nexaminations should be reported in a structured way following the guidelines of \nthe respective national, continental or in ternational societies. Adequate non-\nclinical information (i.e. patient name, date and type of examination, etc). is \nindispensable. Any breast imaging report has to follow a stringent structure \nincluding indication, clinical history,  clinical findings, brief description of \ntechnology used, assessment of parenchymal density, detailed description of \nsignificant findings, comparison with previous imaging studies and final \nassessment according to BI-RADS. Indications and contraindications of breast \nMRI will be discussed. Significant findings at breast MRI include foci (small \ncontrast-enhancing spot, NOS, < 5 mm), mass lesions, \"non-mass-like \nenhancement\" (no mass lesion, partly diffuse regional contrast enhancement of \nvarious size) and associated findings. Furthermore, as breast MRI is a \nfunctional study, the different appearance patterns of kinetic contrast \nenhancement will be presented. The current status and the appropriate use of \nthe BI-RADS MRI lexicon will be discussed. Any breast MRI report should not \nonly follow the guidelines, but also follow a red thread, be consistent, express \nconfidence and be comprehensible to clinicians. The overall final BI-RADS \nassessment is based on the most worrisome finding, taking into account both \nbreasts and all imaging methods (mammography, ultrasound, MRI) evaluated. \nFurthermore, adequate communication of the result, as well as do's and don'ts \nof the report wording will be discussed.  \nLearning Objectives:\n1. To become familiar with BI-RADS MRI descriptors and assessment \ncategories. \n2. To learn how to integrate clinical information and conventional imaging \nfindings into a breast MRI report. \n3. To learn how to compose a complete report with all morphological and \nkinetic information obtained. \n10:30 - 12:00 Room G/H  \nEFOMP Workshop  \nBetween diagnosis and therapy:  \nnew technology in imaging of the prostate  \nEF 2  \nNovel approaches to imaging and \ntreatment  \nModerators:  \nO. Ciraj-Bjelac; Belgrade/RS \nR. Padovani; Udine/IT \nA-257 10:30 \nHigh intensity focussed ultrasound for the treatment of prostate disease  \nG. ter Haar; Sutton/UK (gail.terhaar@icr.ac.uk) \nHigh-Intensity focused ultrasound provides a method of selectively delivering \nablative thermal energy to a predetermined tissue volume whilst leaving \nsurrounding and overlying tissues unharmed. For the prostate, three potential \ntreatment routes are available: trans-perineal, trans-urethral and trans-rectal. \nThe trans-rectal approach, under ultrasound guidance, has been the most \ncommonly used clinically. Whole gland, nerve sparing and partial ablations \nhave all been used. The principles of the HIFU technique, available devices \nand published clinical results will be discussed.  \nLearning Objectives:\n1. To learn about high intensity focused ultrasound (HIFU) and its use in \nprostate disease. \n2. To appreciate the advantages and disadvantages of HIFU treatments of the \nprostate. \nAuthor Disclosure:\n G. ter Haar: Equipment Support Recipient; Philips. \nA-258 11:00 \nMR imaging of the prostate  \nG. Payne; London/UK (Geoffrey.Payne@icr.ac.uk) \nThe prostate is a small glandular organ, whose main function is to secrete \nseminal fluid. In young men it comprises of mainly the peripheral zone (70%) \nand a smaller central gland. However, the central gland enlarges with age to \nform the larger part. The main diseases of the prostate are inflammation, \nhyperplasia, and cancer (the most important). Approximately 70% of cancers \narise in the peripheral zone. The main applications of MRI are for cancer \ndetection, staging, and recurrence. MRI is increasingly used for radiotherapy \nplanning owing to its good soft-tissue contrast when compared with CT \nscanning. Endo-rectal RF receiver coils, usually inflated with air or \nperfluorocarbon but sometimes of a rigi d design, improve signal detection of \nthe prostate. Phased-array surface coils may also be used or (preferably) in \ncombination. T\n1-weighted imaging helps to distinguish haemorrhage caused by \nbiopsy. On T2-weighted images the peripheral zone appears brighter, owing to \na larger proportion of prostatic ducts, while tumours generally appear darker. \nMore sophisticated MR methods are increasingly used to help diagnosis. In \ndiffusion-weighted images (DWI) tumours appear relatively bright, but dark in \nthe corresponding calculated map of A pparent Diffusion Coefficient (ADC), \nowing to the more cellularly-dense nature of tumours, and hence, reduced \ndiffusion. In dynamic contrast-enhanced MRI (DCE-MRI) tumours appear bright \nowing to increased vasculature. Magnetic resonance spectroscopic imaging \n(MRSI) of normal prostate is dominated by high levels of citrate from the \nprostatic ducts; in cancer this is reduced while choline is increased. \nProstatectomy samples allow one to verify image contrast against histology.  \nLearning Objectives:\n1. To become familiar with the main methods and applications of MRI in \nprostate. \n2. To understand some of the problems associated with prostate MR. \nA-259 11:30 \nNew developments in molecular imaging of the prostate  \nM. de Jong; Rotterdam/NL (m.hendriks-dejong@erasmusmc.nl) \nRecent studies on prostate cancer have provided a number of relevant targets \nfor imaging and treatment purposes. Today, imaging plays an important role in \ndifferent aspects of the disease, but its role should grow in answering clinical \nquestions at various phases of the disease. Relevant targets for imaging \ninclude metabolites (including glucose, acetate, choline, and amino acids), \nantigens (including prostate-specific membrane antigen), receptors (GRP \nreceptor, CXCR4, androgen receptor), proliferation, angiogenesis, and \nhypoxia. In this presentation, a range of radiotracers for potential use in the \n\nA B C D E F G S60  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nimaging of prostate cancer will be discussed, as well as options to tailor \nnuclear imaging tracers to the various phases of the heterogeneous disease.  \nLearning Objectives:\n1. To learn about biomarkers for molecular imaging of the prostate. \n2. To appreciate new ways to improve molecular imaging of the prostate. \n10:30 - 12:00 Room N/O  \nJoint Session of ESR/ESMOFIR and ESMI  \nMolecular and functional imaging methods \nfor interventions  \nModerators:  \nP. Brader; Vienna/AT \nF.M.A. Kiessling; Aachen/DE \nA-260 10:30 \nInterventional oncology based on molecular and functional imaging  \nR. Bale; Innsbruck/AT (reto.bale@i-med.ac.at) \nThe fusion of morphologic (CT and MRI) and functional (PET, SPECT) imaging \nmodalities (PET, SPECT) has become widely available and part of the \nstandard diagnostic workup in cancer patients. For many years, neurosurgeons \nhave already relied on multimodal imaging data during brain tumour surgery to \nidentify hyper- or hypometabolic tissue. The availabilit y of PET  and SPECT\ndata during percutaneous ablation procedures may also be helpful to facilitate \ntreatment planning, probe placement, probe re-positioning, and early detection \nof residual disease following percutaneous image-guided ablation of cancer. \nHowever, up to now conventional US- and CT-guided thermal ablation \nprocedures rely on morphologic information only. Intraoperative \nimplementation of multimodal data requires the application of frame-based or \nframeless stereotactic techniques, both relying on the establishment of an \naccurate relationship between the patient's preoperative image space and the \nintraoperative physical space. In image-guided neurosurgery, \nCT/MRT/SPECT/PET data are registered to the patient using rigid body \ntransformation. Due to respiratory motion and different patient positioning \nduring image acquisition and the actual in tervention, soft tissue deformations in \nthe liver occur. Thus, the images and the surgical presentation do not match \nbetween preoperative imaging and intervention, leading to an extensive \ndegradation of spatial guidance. This presentation illustrates solutions for these \nfundamental problems that occur during 3D-navigated liver interventions, \nincluding patient immobilisation and repositioning, respiratory triggering and \nintraoperative imaging. In addition, examples of CT/MRI/SPECT/PET-guided \nstereotactic and robotic liver tumour biopsies and ablations (RFA, MWA, IRE) \nare demonstrated.  \nLearning Objectives:\n1. To learn about new image-guided therapies using molecular and functional \ninformation. \n2. To become familiar with MI methods used for guiding interventions. \n3. To understand new ablation techniques like electroporation. \nAuthor Disclosure:\n R. Bale: Equipment Support Recipient; iSys has supported the Section of \nMicroinvasive Therapy with testing equipment. Patent Holder; RB is a (co-) \ninventor of the Atlas aiming device and the BodyFix immobilisation device and \na (co-)shareholder in its financial returns. \nA-261 11:00 \nMR-guided focused ultrasound in drug delivery and gene expression  \nC. Moonen; Utrecht/NL (C.Moonen@umcutrecht.nl) \nThe goal of ultrasound-triggered, image-guided drug delivery is to increase the \ntherapeutic index and decrease adverse effects of drugs. The bio-effects of \nfocused ultrasound can lead to local ti ssue heating, cavitation, and radiation \nforce, which can be used for 1) local drug release from nanocarriers circulating \nin the blood, 2) increased extravasation and cellular uptake of drugs and/or \ncarriers, and 3) enhanced diffusivity of drugs. Thermo-sensitive liposomes \nhave been suggested for local drug release in combination with local \nhyperthermia more than 25 years ago. Microbubbles may be designed to \nenhance cavitation effects. Real-time imaging methods, such as magnetic \nresonance, as well as optical and ultrasound imaging have led to novel insights \nand methods for ultrasound-triggered drug delivery. Image guidance of \nultrasound can be used for: 1) target identification and characterisation; 2) \nspatio-temporal guidance of actions to release or activate the drugs and/or \npermeabilise membranes; 3) evaluation of biodistribution, PKPD; 4) \nphysiological read-outs to evaluate the therapeutic efficacy. Liposomes may \ncarry both hydrophilic and hydrophobic drugs in their aqueous interior and lipid \nbilayer membrane, respectively. The circulation half-life may be increased by \nincorporating polyethylene glycol (PEG)-lipids in the bilayer. Recent \npublications have shown that ultrasound-triggered delivery is feasible. Real-\ntime imaging methods, such as magneti c resonance, optical and ultrasound \nimaging may lead to novel insights and methods for ultrasound-triggered drug \ndelivery.  \nLearning Objectives:\n1. To learn about the basic principle of MR-guided focused ultrasound and \ndrug delivery. \n2. To appreciate the potential clinical applications of these methods. \n3. To understand how MR-guided focused ultrasound can monitor gene \nexpression. \nAuthor Disclosure:\n C. Moonen: Research/Grant Support; Philips Healthcare, Celsion Corp. \nA-262 11:30 \nIntraoperative imaging: a new dimension of imaging for radiology  \nV. Ntziachristos; Munich/DE \nUp to now, the success of surgical tumour resection has always been limited \nby the surgeon´s vision. The human eye is not an accurate detector of small \ncancer cell clusters and it cannot accurately differentiate cancerous from \nhealthy tissues due to lack of \"visible\" contrast. By combining a fluorescent \nprobe targeting the folate receptor and a multi-spectral real-time fluorescence \ncamera to observe the operating field, we found that, using fluorescence \nmolecular imaging, 3-fold more lesions can be identified compared to \nconventional surgery. These first in-human results point to molecular-based \nclinical decision-making in surgical and endoscopic procedures as a paradigm \nshift over decision-making based on hum an vision. The talk describes current \nprogress with instruments, methods and applications in the field of intra-\noperative imaging. Pre-clinical and clinical results are presented and the \nadvantages and limitations of the method as well as future directions will be \ndiscussed. The emerging field of multispectral optoacoustic tomography \n(MSOT) is also outlined.  \nLearning Objectives:\n1. To learn that intraoperative molecular imaging has the potential to shape the \nfuture of surgical procedures. \n2. To understand that this techniques can improve the sensitivity, accuracy and \ncontrast of tumour delineation and lymph node interrogation. \n3. To learn about further advances in the development and clinical translation \nof intraoperative imaging modalities. \n12:15 - 12:45 Room A  \nPlenary Session \nHL 2  \nWilhelm Conrad Röntgen Honorary \nLecture  \nPresiding:  \nV.E. Sinitsyn; Moscow/RU \nA-263 12:15 \nMysteries of the human brain unveiled: imaging of white matter \nmicrostructure and neuroplasticity  \nP.M. Parizel; Antwerp/BE (paul.parizel@uantwerpen.be) \nThe human brain remains one of nature's great mysteries, and is considered \nscience's final frontier. This greyish lump of tissue with a weight of 1.5 kg \ncontains some 100 billion neurons, each of which are connected to thousands \nof other nerve cells in an intricate network of white matter fibers. In the \nprevious century, the brain was perceived as a fixed three-dimensional \nlandscape, with brain functions confined to certain locations (e.g. motor and \nsensory cortex, visual cortex, auditory cortex). This concept of \nneurolocalisationism was in line with the philosophy that there should be \"a \nplace for everything, and everything should be in its place\". Advanced \nquantitative MRI techniques for acquisi tion and data analyis (fMRI, DWI, DTI, \nVBM), help to unravel white matter connectivity of the human brain, and are \nable to show that the brain can modify its structure and function in response to \nchanging circumstances (such as learning, memory, hormones). This process, \nwhich is known as neuroplasticity, occurs at different levels and different time \nscales. For example, in response to injury, changes may occur at cellular level \nas well as on a larger scale with cortical remapping. Some processes may take \nmonths or years (e.g. physical therapy and training) whereas some forms of \nneuroplasticity happen within hours or days (e.g. changes in brain volume and \nconnectivity during the female menstrual cycle, which have been linked to \nbehavioral changes). In summary, quanti tative MRI techniques help to unveil \nthe mysteries of the human brain and ha ve opened exciting new fields of active \nresearch such as white matter connectivity and neuroplasticity.  \nAuthor Disclosure:\n P.M. Parizel: Board Member; icoMetrix. Founder; icoMetrix. \n\nA B C D E F G S61  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n12:30 - 13:30 Room E2  \nThe Beauty of Basic Knowledge: Skeletal Radiology  \nMC 26C  \nInflammatory/infectious disorders  \nModerator:  \nV.N. Cassar-Pullicino; Oswestry/UK \nA-264 12:30 \nInflammatory/infectious disorders  \nV.N. Cassar-Pullicino; Oswestry/UK (Victor.Pullicino@rjah.nhs.uk) \nThere are a host of inflammatory and infective insults that can manifest focally \nor diffusely within the musculoskele tal system. The appearances of the \nunderlying pathological processes in both the soft tissues and skeleton cover a \nvery wide imaging spectrum. The appearances vary, depending on the timing \nand degree of inflammatory insult and the host response in the involved \ntissues. The approach of this lecture will cover the imaging manifestations \nusing all modalities covering radiography, ultrasound, CT, scintigraphy and \nmagnetic resonance imaging. The basic knowledge that is required will be \ndisplayed in 4 major musculoskeletal cate gories covering disorders involving \nthe Soft Tissues, Joints, Bones and Entheses. The imaging manifestations will \nalso be linked with the evolution of the pathological processes covering acute, \nsub-acute and chronic stages of the inflammatory/infective disorders. By the \nend of the session the audience should have a clear understanding in making \nbest use of the imaging modalities in the correct diagnosis of a wide variety of \ninflammatory and infective conditions that can affect the musculoskeletal \nsystem.  \nLearning Objectives:\n1. To learn about the pathomechanisms involved in inflammatory and \ninfections disorders. \n2. To understand the imaging appearances and their differential diagnosis in \nthe acute, sub-acute and chronic phases of infection. \n3. To become familiar with the spectrum of imaging features of inflammatory \ndisorders in the axial and peripheral skeleton. \n12:30 - 13:30 Room F1  \nThe Beauty of Basic Knowledge: Interventional Radiology  \nMC 25C  \nBasics of arterial PTA/stent  \nModerator:  \nM. Bezzi; Rome/IT \nA-265 12:30 \nBasics of arterial PTA/stent  \nR. Uberoi; Oxford/UK (raman.uberoi@orh.nhs.uk) \nArterial PTA and stenting is firmly established as primary treatment in the \nmanagement of athero-occlusive disease, particularly of peripheral limb arterial \ndisease (PAD). Patients are selected on the basis of symptoms such as short \ndistance claudication or critical limb ischaemia for lower limb disease or \nappropriate ischaemic symptoms in other territories in the renal and mesenteric \nterritories and head and neck vessels. Commonly used grading systems such \nas the Fontaine or Rutherford scores can be useful in patient selection. Where \ntreatment is required, noninvasive imaging is utilised to look for the site, \nseverity and extent of arterial disease. Most centers use duplex imaging as the \nprimary imaging modality; MRA or CTA are often used with a higher sensitivity \nand specificity; and invasive angiography is reserved for problem solving or \nimmediately prior to intervention. The T ASCII classification has been devised \nto select patients for either endovascular or surgical intervention. However, \nmost centres will adopt an endovascular approach first. All patients should be \non good medical therapy, i.e. aspirin and statins, with good blood pressure and \ndiabetic control where appropriate. When carrying out interventions, an access \nsheath is used, peri-procedural heparin administered and lesions crossed \nusing selective catheters and commonly hydrophilic guidewires. Subintimal \ncrossing of occlusions can be much simpler than trying to cross lesions \nluminally. Balloon angioplasty and or stenting may be applied differently \ndepending on the site and extent of the lesions. The evidence for drug-eluting \ntechnologies has also been growing with improved patency rates compared to \nstandard balloon angioplasty.  \nLearning Objectives:\n1. To understand the clinical principles of patient selection and preprocedural \nimaging. \n2. To understand how to gain safe access for PTA, and to learn about the \nrange of techniques available for safely crossing arterial stenosis and \nocclusions. \n3. To become familiar with the indications for arterial stenting and correct \nballoon, or stent, selection. \n14:00 - 15:30 Room B  \nEFRS meets Russia  \nEM 5\nThe role of the radiographer in image \nacquisition and processing  \nModerators:  \nS. Geers Van Gemeren; Utrecht/NL \nS. Mamedova; Moscow/RU \nA-266 14:00 \nIntroduction  \nS. Geers-van Gemeren1, S. Mamedova2; 1Utrecht/NL, 2Moscow/RU\nDuring the EFRS meets Russia session, radiographers have the opportunity to \nget information about the role and education of radiographers in the different \nEuropean countries. The radiographer is a health-care team member who \ninteracts with other professionals in the primary and secondary health-care \nenvironment to provide an optimu m diagnostic or therapeutic outcome. \nRadiographer education therefore requires that the curriculum covers a wide \nrange of scientific, medical, pathological , sociological, ethical and technical \nsubjects together with the development of appropriate clinical skills. The \ncurriculum should also include the development of research and audit skills to \nensure the constant improvement of service quality for the benefit of service \nusers. The session will include a panel discussion about the role of the \nradiographer in image acquisition and processing.  \nSession Objectives: \n1. To understand the background of education and training in Russia. \n2. To gain awareness of the importance of education and training in Europe. \n3. To understand the common issues among radiographers in Europe. \nA-267 14:10 \nMRI safety: the radiographers' role  \nV. Labutin; Chelyabinsk/RU (vlad_lab@mail.ru) \nThe tasks of the assistant to the radiologist are: filling of the protocol of \nresearch, survey of the patient, instructing the patient according to safety \nmeasures, positioning the patient, placement of coils of strengthening, \nbeginning of magnetic and resonant research - the research is approved by the \ndoctor, introduction of contrast substance (in the presence of the certificate of \nthe procedural sister) and supervision over the patient during MR research. \nFurthermore, the other tasks are briefing on patient safety, excluding \nintroduction of the patient to metal objects on MR tomography, explaining the \nprocedure of the study, informing about the duration of the study, wearing \nnoise-cancelling headphones, warning about possible vibration and loud \nsounds, and providing a globular button to call the nurse.  \nLearning Objectives:\n1. To understand the safety aspects of MRI practice. \n2. To understand possible safety measures in MRI practice. \n3. To gain awareness of the radiographers' role in MRI safety. \nA-268 14:25 \nContribution of radiographer to success of coronary MDCT  \nE. Hichina; Moscow/RU (lenahichina@mail.ru) \nToday coronary CT-angiography has become a well-established and proven \ndiagnostic modality. Quality of coronary and cardiac CTA datasets has \ntremendous significance for correct diagnosis. A radiographer has a pivotal \nrole in performance of coronary CTA. Coronary CTA is one of the most \nchallenging examinations for radiographers because even a small mistake at \nany stage of examination may ruin the whole study. Before the scanning \nprocedure, the radiographer performs a check for possible contraindications to \ncontrast media injection (history of adverse reactions to contrast media and \nimpairment of renal function are the most important ones). The radiographer \nchecks the patient's heart rhythm and takes part in administration of beta-\nblockers for control of the heart rate. A detailed knowledge of different \nscanning modalities of CT-machine is a must. Radiation exposure to the \npatient from coronary CTA examinations has been one of the major public \n\nA B C D E F G S62  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nconcerns. This is why the radiographer should be aware of different \napproaches to the performance of low-dose CTA (prospective gating, tube \ncurrent modulation, high-pitch scanning) according to patient body \ncomposition. The radiographer should have knowledge of when and how to \nuse radiation dose control in an appropriate way. Another big issue is injection \nprotocols. Selection of optimal bolus timing and iodine load results in high-\nquality CTA images. The radiographer has to know the basics of CT image \nreconstruction and interpretation in order to perform different types of \nreconstructions from the raw data according to the radiologist's requests and \nbe able to recognise image artifacts. Clinical examples of the radiographer's \nrole for performance of coronary CTA will be given.  \nLearning Objectives:\n1. To learn the importance of patient selection and preparation in achieving \nhigh quality scans. \n2. To understand the practical techniques available for performing of low-dose \nCTA, injection protocols. \n3. To learn how to recognise image artifacts.  \nA-269 14:40 \nInterlude: Russian art and culture  \nI. Arkhipova, V. Sinitsyn, E. Mershina; Moscow/RU (iarkhipova77@mail.ru) \nEvery country is famous for its architecture, history, literature, music, \nmuseums, etc. However, there are some distinctive features for Russia. \n\"Russia is a riddle wrapped in a mystery inside an enigma.\" These words by \nthe famous British statesman Winston Churchill aptly throws light on the \npulsating art and culture of Russia. The different aspects of Russian art and \nculture find its best expression in the rich heritage. Just feeling the nature and \nboundless expanses of the country can understand the mysterious Russian \nsoul, works of art and real masterpieces.  \nA-270 14:50 \nCardiac MDCT in children with congenital heart diseases  \nV. Bereznitskiy, K. Serkova; Moscow/RU (vsber@mail.ru) \nIn CT studies of children with congenital heart diseases, it is mandatory to \nkeep the x-ray dose, amount of contrast agent and study time as low and as \nshort as possible and simultaneously get the best diagnostic image quality. \nHow can we reduce the x-ray dose? By minimising the volume coverage, \nreducing the voltage, minimising the effect of \"overranging\", use of x-ray \nprotective equipment, use of tube current  modulation technique, use of iterative \nreconstruction technique. How can we reduce the amount of contrast agent by \nvolume? By covering of only necessary anatomic volume, minimising scanning \ntime, use of adequate speed injection in ml/sec, which depends on catheter \nposition and size, blood flow and anatomic structures. How can we reduce the \namount of iodine concentration in the contrast agent? By lowering the voltage \nwe may reduce the iodine concentration and get higher absorption CT values \n(HU). How can we reduce the time of cardiac CT studies? By preparing the \nstudy protocol ahead, preparing all necessary equipment in the CT room, \nwarming up of the contrast agent before the study. What is the radiographer's \nrole in cardiac CT studies? To take car e along with the responsible radiologist \nthe above-mentioned needs, to take care of adequate room and instrument \ntemperature, to take care that only absolutely necessary people with adequate \nx-ray protection are in the study room, for performing the necessary image \npost-processing, archiving and distribution of studies.  \nLearning Objectives:\n1. To understand MDCT techniques in cardiac imaging. \n2. To learn about the use of MDCT for children with congenital heart disease. \n3. To gain awareness of the radiographers' role in cardiac MDCT. \nA-271 15:05 \nMDCT in polytrauma patients: the radiographers' role  \nA. Tarasenko, E. Iasakova; Krasnodar/RU \nThe purpose is to evaluate the quality of imaging in forced position of patients \nwith anesthetic support. The role of laboratory technician in CT post \nprocessing. We analysed images of unconscious patients on artificial lung \nventilation on 24- and 64-slice computer homographs GE and Siemens and \nmonitored them through the infusion. During investigation the patients were in \nforced positions, as a result they got artifacts from upper extremities on the \nabdominal cavity. We analysed 157 patients - hands under the butt, 135 \npatients - hands on the chest (abdomen), 57 patients - arms along the body. \nAccording to the images the smallest number of artifacts was identified when \nthe patient was on the table with hands under the butt. Different variations of \nthe patient's hands position and the problem of choice of this position will be \noffered for researching. The reconstruction the laboratory assistant can \nexecute and also the results of tests will be presented. By order of the doctor \nthe laboratory technician builds 3D and 4D reconstructions of fractured ribs, \npelvis, facial skeleton, sagittal and coronary reconstructions of spine in case of \nits fracture.  \nLearning Objectives:\n1. To understand MDCT techniques. \n2. To learn about the use of MDCT for polytrauma patients. \n3. To gain awareness of the radiographers' role in image acquisition. \nPanel discussion:  \nThe radiographers' role in image acquisition and processing  \n15:20\n14:00 - 15:30 Room P  \nMITIGATE Session  \nMolecular imaging and targeted-image \nguided therapy in gastrointestinal stromal \ntumours\nModerators:  \nS. Aime; Turin/IT \nS.O. Schönberg; Mannheim/DE \n14:00 \nIntroduction  \nS. Aime1, S.O. Schönberg2; 1Turin/IT, 2Mannheim/DE  \nA-272 14:10 \nIntroduction to the MITIGATE concept  \nS.O. Schönberg; \nMannheim/DE (stefan.schoenberg@rad.ma.uni-heidelberg.de) \nGastrointestinal stromal tumours (GIST)  are a rare disease that metastasises \nin up to 85% of patients with subsequent median progression-free survival \n(PFS) of around 30 months. Tumours are characterised by activating mutations \nin the KIT or the PDGFRA gene and treatment is mainly based on tyrosine \nkinase inhibitors designed to block mutated receptors. However, drug \nresistance is often based on mutations changing the conformity of the receptor, \nleaving little effective therapeutic opti ons. To date, second line chemotherapy \noffers a median PFS of 6-9 months and external beam radiotherapy is limited \nby organs at risk close to the tumour. Alternative approaches like \nendoradiotherapy or minimally-invasive ablation techniques are effective for \nlocal control but are inconsistently used and are not tailored to the individual \npatient's type of disease. To address these issues, the MITIGATE project \nproposes a closed-loop personalised treatment concept combining \nendoscopic-assisted tissue sampling, inline biotechnology and targeted \nmolecular PET imaging probe development combined with minimally-invasive \ntreatment monitored by new MR imaging techniques. A consistent value chain \nacross European research institutes and SMEs will be established for mass \nspectrometry of tumours, linkage of radiochemical molecular imaging probes, \ndesign of new animal models and targeted therapeutic radiopharmaceuticals. \nThis closed-loop platform will minimise fragmentation of treatment approaches \nby a coherent molecular-based multimodality concept, thus providing new \ntreatment options. The MITIGATE platform can be expanded to further patient \ncohorts with oligometastatic diseases such as other sarcomas or renal cell \ncarcinoma.  \nAuthor Disclosure:\n S.O. Schönberg: Research/Grant Support; EU-FP7 Project (2013-2017). \nA-273 14:25 \nMolecular imaging and targeted endoradiotherapy: key methods to \novercome TKI-resistancies?  \nB. Wängler; Mannheim/DE (Bjoern.Waengler@medma.uni-heidelberg.de) \nGastrointestinal stromal tumours (GIST) are characterised by highly specific \ngenetic mutations. Several specific targets are overexpressed in a majority of \nthe tumours. On the other hand, secondary resistancies limit the usability of \nhighly specific chemotherapeutics such as Imatinib. Instead of applying \ncascades of alternative TKI inhibitors in order to find an efficient one, \nquantitative molecular imaging and targeted Endoradiotherapy could be \nconsidered. For the detection of GIST by imaging, 18 F-\nfluorodeoxyglucose (FDG)-PET is widely accepted to visualise the tumour \nburden. However, as FDG gives no molecular information of potential targets \nfor treatment, new radiopharmaceuticals have to be developed to visualise and \nquantify other target-structures expressed by GIST that would be able to be \naddressed. This molecular information can be used both for designing a \nconventional treatment or an advanced strategy: i.e. targeted \nendoradiopharmaceuticals. Compared to conventional chemotherapy this \nmethod has the great advantage that not only tumour cells expressing the \ntargeting vector are affected but also tumour cells within the range of the \nradiation of the decaying radiopharmaceutical. This method is used with great \nsuccess in the case of neuroendocrine tumours using labeled octreotate \n\nA B C D E F G S63  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nderivatives (a small cyclic peptide binding to the somatostatin-receptor) and \nnon-Hodgkin's lymphoma applying Y-90 labeled Zevalin (a monoclonal \nantibody binding to the CD20 antigen). The success of these methods relies on \nthe crossfire-effect, meaning that a certain margin of tissue surrounding the cell \ntargeted by the specifically accumulating endoradiopharmaceuticals is \ndestroyed as well, depending on the penetration range of the emitted radiation. \nThus, the development of new radiopharm aceuticals for the specific diagnosis \nand treatment of GIST would strongly improve the outcome of the tumour \npatient.  \nA-274 14:40 \nStereotactic radiofrequency ablation of liver tumours: does improved \ntargeting increase tumour response?  \nR. Bale, G. Widmann, P. Schullian, M. Haidu, W.R. Jaschke; Innsbruck/AT\n(werner.jaschke@i-med.ac.at) \nThe purpose is to describe stereotactic radiofrequency ablation (SRFA) and to \nreview its inital results in the treatment of patients with primary and secondary \nliver tumours. One retrospective review includes 90 consecutive patients with \n106 SRFA sessions for the treatment of 72 hepatocellular carcinomas (HCC) \nand 105 metastases (1). In two other studies the outcome after SRFA of \nintrahepatic cholangiocellular carcinomas (ICC) (2) and colorectal liver \nmetastases (CRLM) (3) was evaluated. The overall technique effectiveness \nwas 95.5% with a local recurrence at 1 year of 2.9%. Technique effectiveness \nwas not significantly different for lesions < 3 cm (95.9%) and 3-5 cm (100%). \nAfter treatment of 17 inoperable consecutive patients with 52 ICCs a median \noverall survival of 60 months was achieved. A median OS of 58 months and \nOS rates of 92%, 66% and 48% at 1, 3 and 5 years in patients with resectable \nCRLM were achieved. Tumour size did not affect OS and DFS. RFA probes \ncan be precisely planned, positioned and distributed by means of stereotaxy. \nEspecially in large liver tumours the local recurrence rate can be greatly \nreduced by precise stereotactic placement of multiple radiofrequency probes. \nThese improved local control rates result in better long-term survival rates.  \nAuthor Disclosure:\n R. Bale: Shareholder; Coshareholder Atlas aiming device. Other; Coinventor \nAtlas aiming device. \nA-275 14:55 \nFunctional and molecular imaging in tumour therapy response \nassessment  \nS. Aime; Turin/IT (silvio.aime@unito.it) \nIn the MITIGATE project further development of currently used MRI and CT \ntechniques will be tackled in order to obtain functional and metabolic \ninformation which are mandatory to detect early response to the targeted \nradiopharmaceutical approach. New Gd-based agents are under scrutiny in \norder to improve DCE-MRI procedures and attain more precise information on \nthe tumour microvascularity level as well on the vessel permeability and the \nassessment of extracellular pH and MMP activity. The X-nuclei MRI (\n23Na \nsodium) is a non-invasive imaging technique, which enables the measurement \nof the tissue sodium concentration (TSC) in humans. The direct link of the TSC \nwith the tissue integrity and viability provides a promising approach for \nmonitoring tumour tissue, and could also help to assess cytoxicity and cell \ndeath by means of breakdown of the sodium-potassium-pump. However, \n23Na \nMRI is challenging because of the low in vivo abundance, the fast transversal \nrelaxation rate and the low gyromagnetic ratio of the \n23Na ions in human tissue. \nNew MR measuring sequences for X-nuclei MRI will be developed to establish \na standardised TSC measurement method within the EU for better \ncomparability. Furthermore, the X-nuclei MR data will be reconstructed, scaled \nand fused with further imaging modalities.  \nDiscussion  \n15:10\n16:00 - 17:30 Room A  \nInteractive Teaching Session  \nE³ 1120  \nWhat to look for after treatment of lung \ncancer  \nA-276 16:00 \nA. Imaging of surgically treated lung cancer  \nC. Heussel; Heidelberg/DE \nChest x-ray, CT, and MRI are shown to demonstrate early, intermediate, and \nlate findings after lung surgery and during follow-up. Complications frequently \nseen on intensive care unit, \"lines and wires\", typical change of the chest and \ncaveats are shown, \"Problem zones \" of imaging after surgery and hints for \nlong-term follow-up are presented.  \nLearning Objectives:\n1. To appreciate the complications after surgery for lung cancer. \n2. To understand the anatomic changes which occur after surgery for lung \ncancer. \nAuthor Disclosure:\n C. Heussel: Consultant; Schering-Plough, Pfizer, Basilea, Boehringer \nIngelheim, Novartis, Roche, Astellas, Gilead, MSD, Lilly, Intermune, Fresenius. \nPatent Holder; Methods and Device For Representing the Microstructure of the \nLungs. IPC8 Class: AA61B5055 FI, PAN: 20080208038, Inventors: W. \nSchreiber, U. Wolf, A.W. Scholz, C.P. Heussel. Research/Grant Support; \nSiemens, Pfizer, MeVis. Shareholder; Stada, GSK. Speaker; Gilead, Essex, \nSchering-Plough, AstraZeneca, Lilly, Roche, MSD, Pfizer, Bracco, MEDA \nPharma, Intermune, Chiesi, Siemens, Covidien, Pierre Fabre, Boehringer \nIngelheim, Grifols, Novartis. \nA-277 16:45 \nB. Imaging of non-surgical treatment of lung cancer  \nB. Ghaye; Brussels/BE (benoit.ghaye@uclouvain.be) \nLung cancer is the leading cause of death related to cancer. Most patients are \ninoperable as they present with advanced stage disease or even a localised \ntumour associated with poor general condition, limited cardiopulmonary \nfunction or a too high surgical risk. According to the stage of the disease, \nchemotherapy, radiotherapy and percutaneous ablation therapies are the \ncurrent therapeutic options for inoperable patients. It is important that \nradiologists are familiar with the various response and complication imaging \npatterns related to each of those treatments. The timeline modifications after \nradiation therapy and percutaneous ablation and the diagnostic management \nof drug-induced lung disease will be reviewed. This presentation will \nsummarise the current evidence and how to detect early recurrences after \nthose treatments.  \nLearning Objectives:\n1. To learn about changes after radiotherapy. \n2. To learn about sequela after percutaneous ablation of lung tumours. \n3. To understand changes after chemotherapy of lung cancer. \n16:00 - 17:30 Room B  \nESR meets ESC (European Society of Cardiology)  \nEM 3\nThe role of imaging in the cardiac patient  \nWelcome by the ESR President  \nG. Frija; Paris/FR \nPresiding:  \nV.E. Sinitsyn; Moscow/RU \nP.E. Vardas; Iraklion/GR \nA-278 16:00 \nIntroduction  \nP.E. Vardas; Iraklion/GR (cardio@med.uoc.gr) \nCardiovascular medicine owes much of its spectacular development to the \nparallel evolution of imaging techniques in the last thirty years. The complex \ncontemporary techniques in interventional cardiology, electrophysiology, and \ncardiac surgery require advanced imaging modalities. In current times, a wide \nspectrum of imaging techniques - such as fluoroscopy, MRI, non-contact \nmapping, echo techniques - is performed in organised cardiovascular labs \nwhile computed tomography and nuclear techniques are provided by the \ncollaborative departments of radiology and nuclear medicine. It is indeed the \ncollaborative spirit among specialists that bring about the results patients \ndesire.  \nSession Objective: \n1. To better understand the needs of clinicians and what imaging can provide \nin different clinical settings. \nAuthor Disclosure:\n P.E. Vardas: Advisory Board; Menarini, Bayer, Servier. Board Member; ESC. \nEmployee; Iraklion University Hospital. Research/Grant Support; Medtronic, \nBoehringer. Speaker; Menarini, Bayer, Servier, Boehringer, Bristol. \nA-279 16:05 \nAssessing myocardial viability  \nM. Lombardi; San Donato Milanese/IT\n(massimo.lombardi@grupposandonato.it) \nCardiac magnetic resonance (CMR) is a very versatile imaging technique for \nthe assessment of patients with left ventricular dysfunction and has become a \n\nA B C D E F G S64  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\ncentral method for characterising the etiology of the dysfunction. Indeed, wall \nthinning less than 6 mm and aneurysmal motion are morphological signs of \ntransmural necrosis. Furthermore, a low dosage of dobutamine (10-20 \nmicrog/min) is used to detect functional reserve in the case of viable tissue. A \nfurther option offered by CMR is late contrast enhancement (LE) imaging, \nwhich allows identifying the presence of fibrotic tissue as well as necrotic \ninfarcted myocardium. The sensitivity and specificity of late hyperintensity is, \nrespectively, 0.86 and 0.94. Similar results can be obtained with 99mTC-\ntetrofosmina G_SPECT. There is a relation between transmural extension of \nhyperenhancement and the recovery of contractile function after coronary \nrevascularisation. The chance of recovery decreases progressively with the \ntransmural extension of late hyperintensity, since the average value of the \nlatter is 10±7% in the segments that recover and 47 ±14% in the segments that \ndo not recover contractile function. CMR was also shown to be able to predict \nresponse to cardiac resynchronisation Therapy differentiating between \nnonischemic and ischaemic cardiomyopathy LE-CMR may allow to precisely \ndelineate the presence and the location of fibrosis, avoiding the placement left \nventricular leads in necrotic areas and in particular when the scar is located in \nthe posterolateral area.  \nLearning Objectives:\n1. To learn how MRI can help in assessing patients with CAD. \n2. To become familiar with different protocols in CMR, and learn how they can \nbe applied in clinical practice while assessing viability. \nA-280 16:23 \nAssessing acute chest pain  \nR. Rosenhek; Vienna/AT \n\"No abstract submitted\" \nLearning Objectives:\n1. To learn what CT can do in the patient with acute chest pain. \n2. To appreciate the clinical evidence for different applications of CT in this \nsetting. \nA-281 16:41 \nAssessing valvular heart disease  \nS. Muzzarelli1, J. Schwitter2; 1Lugano/CH, 2Lausanne/CH\n(stefano.muzzarelli@cardiocentro.org) \nAt the beginning of the presentation, a short overview will be given on the \nrelevance and prevalence of valvula r heart diseases with special focus on \nEurope and the data collected in the EuroHeart Survey. Also, the aetiologies of \nthe various valve diseases will be briefly mentioned. In the second part, special \nattention will be given to aortic stenosis (AS) and mitral regurgitation (MR), as \nthese two entities are responsible for up to 60% of all valvular heart diseases. \nEchocardiography is well accepted as the backbone examination of any \nvalvular heart disease evaluation. Echocardiographic criteria for severe AS and \nMR are reviewed as well as their importance for the indication of valve repair or \nvalve replacement. In the third part, we will focus on newer \"cross-sectional\" \nimaging technologies such as cardiac MR  and CT. In particular, the strengths \nof cardiac MR in the assessment of regurgitant lesions will be demonstrated. In \naddition, the value of cardiac MR for the pre-interventional evaluation of \ncongenital heart diseases will be discussed. Similarly, the crucial role of \ncardiac CT in the workup for transaortic valve implantation (TAVI) will be \nillustrated. Finally, the yield of these novel techniques in the context of \ncombined valvular and ischaemic heart disease will shortly be reviewed.  \nLearning Objectives:\n1. To better understand the role of cardiac MRI in valvular heart disease. \n2. To appreciate the added value of MRI vs other imaging modailities. \nA-282 16:59 \nAssessing interventions  \nV. Delgado; Leiden/NL (v.delgado@lumc.nl) \nCardiac resynchronisation therapy (CRT) and transcatheter valve heart (THV) \ninterventions have been important therapeutic breakthroughs for heart failure \npatients and patients with valvular heart disease and contraindications for \nsurgery. Patient selection is cruci al to optimise procedural outcomes and \ntherapeutic efficacy. Multimodality imagi ng plays a central role in patient \nselection and procedural strategy planning. Assessment of left ventricular \ndyssynchrony, cardiac venous anatomy and extent and location of myocardial \nscar are key to identify heart failure patients who will respond to CRT. Step-\nwise use of non-invasive imaging modalities, including echocardiography, \nnuclear imaging, magnetic resonance imaging and multidetector row computed \ntomography (MDCT), has been common practice to select patients for CRT. \nRecent technological advances have allowed integration or fusion of imaging \nmodalities to create 3-dimensional models that provide relevant information. \nMultimodality imaging is also crucial to optimise the results of THV \ninterventions. Detailed anatomical and geometrical evaluation of the mitral \nvalve with current 3-dimensional imaging techniques has permitted better \nselection of patient candidates for transcatheter edge-to-edge mitral valve \nrepair and accurate procedural guidance. For transcatheter aortic valve \nimplantation, accurate measurement of the aortic annulus with 3-dimensional \nechocardiography or MDCT allows us accurate selection of the prosthesis size \nto minimise the risk of complications, and evaluation of the procedural access \n(transarterial or transapical) with MDCT permits accurate procedural strategy \nplanning. The learning objectives of thi s session include: providing an overview \nof current imaging modalities to select patients for CRT and THV interventions \nand how to use them in clinical practice.  \nLearning Objectives:\n1. To understand the role of the multimodality approach to cardiac \ninterventions. \n2. To understand how imaging helps in selecting, monitoring and following up \nsuch patients. \nAuthor Disclosure:\n V. Delgado: Consultant; medtronic and St.Jude Medical. \nPanel discussion  \n17:17\n16:00 - 17:30 Room C  \nModern Imaging of the GI Tract  \nCC 1121  \nPerianal fistula disease:  \nall you need to know  \nModerator:  \nD. Weishaupt; Zurich/CH \nA-283 16:00 \nA. Perianal anatomy and imaging techniques  \nK. Horsthuis; Amsterdam/NL (k.horsthuis@amc.uva.nl) \nThe inner layer of the anal canal consists of squamous and columnar \nepithelium with the transitional zone at the dentate line. The muscular \ncomponent of the anal sphincter consists of an inner layer of circular smooth \nmuscle (internal sphincter ), extending downwards from the rectum, and an \nouter striated muscular layer extending downwards from the levator ani \nmuscle, comprising the puborectalis mu scle and the external sphincter. \nBetween these layers is the fat-containing intersphincteric space, including the \ncontinuation of smooth-muscle fibers of the longitudinal muscle of the rectum. \nOutside the anal sphincter is the fat- containing ischioanal space. Magnetic \nresonance imaging (MRI) and endoscopic ultrasonography have become the \nmainstay for preoperative imaging of perianal fistulas. For complex tracts, MRI \nseems preferable. MRI can be performed using an endoluminal coil or a \nphased-array surface coil. A state-of-the-art imaging protocol should include T2 \nTSE sequences in three orthogonal planes, with the axial and coronal \nsequences angulated at the anal canal. Addition of a fat-saturated T2 TSE \nsequence is recommended for optimal conspicuity of inflammatory changes \nand post-contrast T1-weighted imaging can also be helpful. Intersphincteric \ninfection is the principal feature of peri anal fistulas; this is generally not found \nin other conditions. Veins can be mistaken for fistulas, but in contrast to \nfistulas, veins usually are thin-walled, tortuous, symmetric structures. A \npilonidal sinus may resemble a fist ula, but absence of extension to the \nintersphincteric space helps one to discriminate between them. Haemorrhoids \nand anal tags may resemble small submucosal fluid collections, but are easily \ndiagnosed at clinical examination.  \nLearning Objectives:\n1. To understand anal canal anatomy. \n2. To become familiar with state-of-the-art protocols for imaging the anal canal. \n3. To learn about normal variants which mimic anal disease. \nA-284 16:20 \nB. Perianal fistula disease: the basics  \nS. Halligan; London/UK (s.halligan@ucl.ac.uk) \nThis lecture will describe the pathogenesis of fistula-in-ano, with a focus on \ncryptoglandular disease, so that the radiologist can understand how the \nvarious classifications of fistulas arise. The Park's classification for fistula-in-\nano will be described with reference to cryptoglandular disease and other \naetiologies. The surgical questions that need to be answered by imaging will \nbe presented, followed by a description of what the radiologists need to include \nin their report for it to be clinically useful. The role of anal ultrasound and MRI \nfor preoperative fistula imaging will be described, with explanation as to why \nthe latter is fundamental to modern management of the disease.  \n\nA B C D E F G S65  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To understand the pathophysiology and classification of perianal fistula \ndisease. \n2. To become familiar with the role of US and MRI in assessing fistula disease. \n3. To learn about the basic reporting of fistula disease. \nA-285 16:40 \nC. Perianal fistula disease: advanced  \nF. Maccioni; Rome/IT (francesca.maccioni@uniroma1.it) \nPerianal fistulising dise ase develops in approximately half of the adult and \npaediatric patients with Crohn's disease (CD), with a relevant impact on their \nquality of life. In patients with CD, particularly those with severe fistulising ileal \nor colo-rectal disease, complex ramifi ed anal fistulas associated with \nabscesses (Parks' classification type 3-4 or S.James Hospital classification \ntype 4-5) are more frequently observed than in other patients. Perianal disease \nthus represents a severe complication of CD, which may change disease \nmanagement, by requiring specific pharmacological and/or surgical treatments. \nA non-responsive disease eventually may lead to total proctectomy with \nileostomy. MRI represents the gold standard diagnostic modality, because it \nprovides a comprehensive staging of both enteric and perianal disease, with \nhigh accuracy and without invasiveness. Moreover, MRI is the ideal tool for \nmonitoring disease response to therapy, being able to detect the inflammatory \nactivity of perianal fistulas with high accuracy. So far, several clinical indexes \nhave been proposed to measure fistula's activity, including the Perianal \nDisease Activity Index (PDAI). Similarly, several MRI classifications of fistula's \nactivity, based either on T2-weighted or T1-weighted contrast-enhanced \nimaging, have been proposed, although a widely accepted imaging severity \nscore is not available yet. Several cases  of complex perianal fistulising CD of \nincreasing severity will be shown, with anatomical and clinical correlations, \nstaging and activity description, particularly in patient follow-up and treatment \nmonitoring. Finally, differential diagnoses with other benign conditions which \nmay affect the anal canal, including inflammatory infective diseases, \nhydradenitis and pilonidal disease will be discussed.  \nLearning Objectives:\n1. To lean about complex perianal fistula disease, particularly in Crohn's \ndisease. \n2. To understand the role of imaging in patient follow-up and treatment \nmonitoring. \n3. To learn about benign inflammatory conditions which may affect the anal \ncanal, including hydradenitis and pilonidal disease and how they are \ndifferentiated from perianal fistulae. \nA-286 17:00 \nD. Interactive case discussion  \nD. Weishaupt; Zurich/CH (dominik.weishaupt@triemli.zuerich.ch) \nThe interactive case discussion will highlight clinically relevant aspects of \nperianal fistula disease in selected clin ical cases. A patient case of each of the \nsubtopics of the categorical course is presented.  \nLearning Objectives:\n1. To become familiar with typical cases demonstrating the crucial role of \nimaging perianal fistula disease. \n2. To learn about typical imaging findings. \n3. To be aware of potential pitfalls in imaging perianal fistula disease. \n16:00 - 17:30 Room D  \nChest  \nRC 1104  \nPatterns in chest radiology: are there \nsubtype patterns of ground glass opacity \n(GGO)?  \nA-287 \n16:00 \nChairman's introduction  \nA. Oikonomou; Toronto, ON/CA (anastasia.oikonomou@sunnybrook.ca) \nGround̻glass opacity (GGO) is characterised on HRCT by the presence of a \nhazy increase in lung opacity that does not cause obscuration of underlying \nbronchial and vascular margins. Although a very common finding, it also \nconstitutes a very nonspecific term since it can be seen in a variety of different \nintraalveolar and interstitial processes  with different histology including \ninflammatory, infectious and neoplastic diseases that have a common \nphysiologic mechanism: partial displacement of air. Ground ̻glass opacity may \neven be seen in normal processes such as poor ventilation in dependant lung \nareas and in expiration. Moreover, GGO can represent either an ongoing, \nactive and potentially treatable disease or an irreversible process. To interpret \ncorrectly this highly nonspecific but very si gnificant finding, it is crucial to \nattempt to further classify the different large main entities in which this \nradiological finding appears. Are there specific radiological and HRCT findings \nthat can help us differentiate GGO in autoimmune ̻inflammatory conditions \nfrom infectious and neoplastic processes? Are there associated findings other \nthan GGO, such as nodules, reticulation or focal disease, and distribution of \nfindings that can narrow the differential  diagnosis? Systematic evaluation of \nGGO and associated findings as well as integration with clinical information \n(acute, subacute or chronic symptoms) is essential in defining GGO subtypes \nto improve the radiological diagnosis.  \nSession Objectives:\n1. To learn about the prevalence and low specificity of GGO. \n2. To appreciate the need for a definition of GGO subtypes to improve \nradiological diagnoses. \nA-288 16:05 \nA. Ground-glass opacification: why do we see it and what does it mean?  \nS.R. Desai; London/UK (sujal.desai@nhs.net) \nRadiologists who regularly review high resolution CT (HRCT) should be aware \nof the range of patterns and, more importantly, their potential pathological \nmeaning. A pattern of ground-glass opaci fication is one of the more common \nHRCT findings but, to the unwary, its interpretation can be problematic. An \nimportant underlying principle is that a ground-glass pattern may be caused by \nany process - physiological or  pathological - which partially displaces air. \nPhysiological (i.e. non-disease-related) ground-glass opacification is perhaps \nmost commonly seen in subjects who, for whatever reason (e.g. \nbreathlessness, obesity), are unable to maintain or achieve a satisfactory \ninspiratory effort during scanning. A generally increased lung density (in \ncontrast to adults) is also a feature in infants and young children simply \nbecause there are fewer alveoli in the developing lung. Finally, it is worth \nnoting that intravenous contrast administration (presumably because of a \nrelative but temporary increase in capillary blood volume causing partial \ndisplacement of air) can unpredictably increase lung density. Disease \nprocesses which lead to partial filling of the air spaces, thickening of the \ninterstitium, partial collapsing of alveoli, and/or increased capillary blood \nvolume will also manifest as a pattern of ground-glass opacification. In clinical \npractice, the recognised causes of ground-glass opacities on HRCT include \npulmonary oedema (cardiogenic or otherwise), infections (e.g. pneumocystis \njiroveci pneumonia) and some of the idiopathic interstitial pneumonias (e.g. \nnon-specific interstitial pneumonia and respiratory bronchiolitis associated \ninterstitial lung disease). The presentation will review and revise the causes of \nphysiological and disease-related ground-glass opacification on HRCT.  \nLearning Objectives:\n1. To appreciate the different physiological conditions which cause GGO \npattern. \n2. To learn about the associations and reversibility of physiology-related GGO. \nA-289 16:28 \nB. Inflammatory and infectious GGO  \nK. Marten-Engelke; Göttingen/DE (kmarten@med.uni-goettingen.de) \nGround-glass opacity (GGO) is defined as increased attenuation of the lung \nparenchyma without obscuration of the pulmonary vascular markings on CT \nimages. GGO may be the result of a vari ety of interstitial and alveolar \ninfectious and noninfectious inflammato ry diseases. As an imaging finding \nalone, GGO does not usually allow a specific diagnosis. GGO in inflammatory \ndisorders is often present in the company of other interstitial or alveolar \nfindings. However, the number of diseas es that cause diffuse isolated GGO or \nGGO as the predominant finding is relatively small and can be prioritised with \nclinical information. The most common cause of diffuse isolated GGO in \nimmunocompromised hosts are a variety of diffuse, opportunistic pneumonias, \ne.g. pneumocystis jiroveci pneumonia (PCP), cytomegalovirus pneumonia \n(CMV) or herpes simplex pneumonia (HSV), which constitute the first \ndifferential. Chronic onset disorders in immunocompetent patients include \ncellular nonspecific interstitial pneumonia (NSIP), subacute hypersensitivity \npneumonitis (HP), organising pneumonia, air-space sarcoid, and drug-induced \nlung disease. In these disorders, ancillary findings such as an associated \nreticular pattern with traction bronchiectasis/bronchiolectasis (NSIP), \nmediastinal lymphadenopathy (sarcoidosis), superimposed nodularity or cysts \nor may help to refine the diagnosis. In patients with collagen vascular \ndisorders, e.g. scleroderma, GGO secondary to pulmonary involvement needs \nto be differentiated from drug-induced lung disease. This refresher course will \nput GGO in the context of outpatients versus inpatients, the acuity of clinical \nsymptoms, e.g. fever, cough and dyspnoea, signs of massive systemic \ninflammation, and the clinical situation such as inhalational history, \npneumotoxic drug administration, immunocompromise, or bone marrow \nsuppression. \n\nA B C D E F G S66  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To learn more about the inflammatory conditions which cause GGO. \n2. To appreciate the histopathological corr elates of inflammatory and infectious \nGGO. \n3. To become familiar with GGO in autoimmune and infectious lung disease. \nA-290 16:51 \nC. GGO in dysplasia and neoplasia  \nG.R. Ferretti; Grenoble/FR (GFerretti@chu-grenoble.fr) \nIn this course, we will review the dysplastic and neoplastic conditions that are \nassociated with persistent GGO in the lung parenchyma. We will separate \nthese conditions into those that are responsible for localised diseases such as \nsingle nodular GGO and those responsible for more extended diseases. \nNodular GGO can be separated into pure or mixed or part-solid nodules. \nPathology-radiology correlations show that nodular GGO are related to atypical \nadenomatous hyperplasia (AAH), adenocarcinoma (ADC) in situ (AIS), \nminimally invasive ADC (MIA), and invasive ADC according to the new \nIASLC/ATS/ERS lung adenocarcinoma cl assification. Diffe rential diagnosis \nincludes exceptional metastases of angiosarcoma and melanoma as well as \ninfection, inflammation and localised fibrosis. Diffuse GGO related to neoplastic \nconditions is rare and may be due to lepidic ADC (former advanced ADC with \nBAC component), diffuse large B-cell non-Hodgkin's lymphoma, intravascular \nlymphomatosis (IVL) or mucosa-associated lymphoid tissue (MALT) \nlymphoma. These neoplastic diseases should be differentiated from infectious \nand inflammatory causes of diffuse GGO. We will review the value of different \nmorphological CT criteria to differentiate benign from malignant localised GGO, \nsuch as the size, the morphology (round, oval, flat), presence of mixed vs. pure \nGGO, and the multiplicity of nodular shadows. Discussion will also include the \nchanges that may occur within the nodule as well as the mean doubling time. \nThe role of PET CT and transthoracic biopsy will be discussed. Finally, we will \npresent the current recommendations regarding the management of nodular \nGGO.  \nLearning Objectives:\n1. To learn more about the dysplastic and neoplastic conditions causing GGO. \n2. To appreciate the histopathological correlates of dysplastic and neoplastic \nGGO. \n3. To understand how to estimate malignancy on the basis of GGO pattern. \nPanel discussion:  \nHow should we report and manage ground glass opacity?  \n17:14\n16:00 - 17:30 Room E1  \nMusculoskeletal  \nRC 1110  \nThe ankle and foot  \nModerator:  \nS.J. Ostlere; Oxford/UK \nA-291 16:00 \nA. Ankle sprain: patterns of injury  \nJ.L.M.A. Gielen, P. Van Dyck, J. Veryser; Antwerp/BE (jan.gielen@uza.be) \nIt is the purpose of this lecture to brief ly discuss ankle distortion-related lesions \nwith emphasis on failed radiographic diagn osis, discuss their significance and \nmanagement implications and define the diagnostic pathways in the acute and \nsubacute stage. Significant lesions are those with no return to sports activities \nafter 12 months; these have our major interest. In the acute setting of ankle \ndistortion, the Ottawa clinical decision  rules are accepted to decide whether or \nnot radiographic evaluation is needed; about 35% of radiographic examinations \ncan be avoided. Additional evaluation is re stricted to patients with residual pain \nduring reevaluation one week after trauma. Assessment of fractures with the \nLauge Hansen classification has a major advantage, as it defines the stability \nat the talocrural and distal tibiofibular jo int. Only in restricted cases, additional \nexaminations may be needed to rule out instability. Although radiographs \neasily detect displaced fractures, occult fractures may occur; also, grade II-III \nligament lesions and peroneal tendon dislocation may go undetected. \nAdditional imaging evaluation should focus on the detection of significant \nlesions. Significant lesions are talar fractures and complete calcaneofibular \nligament tears. The latter is explained by the instability at the level of the \nsubtalar joint with associated sinus tarsus syndrome. In case of residual local \ntenderness posterior and inferior to the lateral malleolus, the fibulocalcanear \nligament and retinaculum peroneorum lesions are best evaluated with \n(dynamic) ultrasound. MRI or CT is used to detect occult fractures in case of \nresidual talocrural joint effusion with anterior talar tenderness during \nendorotation and plantar flexion.  \nLearning Objectives:\n1. To learn more about the imaging appearances of soft tissue and \nosteoarticular injury. \n2. To become familiar with the patterns of bone and soft tissue injury in the \nankle and foot. \nA-292 16:30 \nB. Inflammatory disorders  \nR. Lalam; Oswestry/UK (radhesh.lalam@rjah.nhs.uk) \nThe ankle and foot can be affected by inflammation from a number of \ndiseases. The main focus of this lecture will be inflammation secondary to \ninfection and systemic inflammatory disorders. Due to its function in locomotion \nand weightbearing, the foot is specifically susceptible to infections secondary \nto penetrative trauma including foreign bodies or to abnormal repetitive \npressure. In addition, both seropositive and seronegative arthropathies can \naffect the foot. Other unusual causes of inflammation include chronic recurrent \nmultifocal osteomyelitis, osteoarthritis, mechanical disorders and sensory loss. \nThis lecture will deal with the various patterns of inflammation in the context of \npathogenesis and discuss the imaging features that aid in diagnosis. The \nimportance of the clinical context in diagnosis will also be discussed.  \nLearning Objectives:\n1. To learn more about the imaging appearances of soft tissue and \nosteoarticular inflammation. \n2. To become familiar with imaging findings of specific inflammatory conditions. \nA-293 17:00 \nC. Tumours and tumour-like lesions  \nI.-M. Noebauer-Huhmann; Vienna/AT (iris.noebauer@meduniwien.ac.at) \nSoft tissue tumours of the foot and ankle are rare. This leads to frequent \nmisdiagnosis or diagnostic delay, which is of importance, especially in the few \npatients with unsuspected malignancy. By the use of ultrasound, some entities \nwhich are clearly benign and do not require further imaging can be identified. In \nthe other lesions, MR is the imaging modality of choice; additionally, \nradiography should be performed. Several common benign soft tissue tumours \nand those of intermediate type, as well as tumour-like lesions of the foot and \nankle region, exhibit typical MR features, e.g. the Morton neuroma, the plantar \nfibromatosis and aggressive fibromatosis/ extra-abdominal desmoids, lipoma, \nganglia, and also vascular malformations and extraskeletal chondromas. MR \nfindings of synovial lesions, such as pigm ented villonodular synovitis (PVNS) \nand the giant cell tumour of the tendon sheath (GCTTS), as well as synovial \nchondromatosis, are also characteristic. It is important not to misdiagnose the \nmost common malignant tumour of that region, the synovial sarcoma, as the \ngrowth rate may be slow. The same is true for clear cell sarcoma, which tends \nto have a high incidence of distant metastases and a high recurrence rate. \nLesions that are indeterminate or likely malignant require histologic diagnosis. \nBiopsy may be performed by ultrasound or MR guidance. The importance of \nMRI for staging of soft tissue tumours will be discussed, including the \nrecognition of compartmental involvement and relation to adjacent \nneurovascular structures.  \nLearning Objectives:\n1. To learn more about the spectrum of intra and para-articular soft tissue \ntumours, and tumour-like soft tissue lesions. \n2. To become familiar with US and MRI findings of specific soft tissue lesions. \n16:00 - 17:30 Room E2  \nMultidisciplinary Session: Managing Patients with Cancer  \nMS 11\nCharacterisation and treatment of renal \ntumours: new paradigms  \nA-294 16:00 \nChairman's introduction  \nN. Grenier; Bordeaux/FR (nicolas.grenier@chu-bordeaux.fr) \nThis session will be devoted to recent changes of paradigms in the \nmanagement of renal tumours. Fist, characterisation of solid renal tumours has \nimproved, using an association of morphological and functional information, \nusing US, CT and, more recently, multiparametric MRI, and by extending the \nindications of percutaneous biopsy in undetermined cases. Second, surgical \nand radiological treatments have improved with the development of indications \nand techniques of nephron-sparing procedures (open, laparoscopic or \nrobotised) and of percutaneous thermoablations (RF, cryo, microwaves, \nelectroporation), with a larger consideration of active surveillance for the \nelderly. Third, antiangiogenic treatments have changed the prognosis of \n\nA B C D E F G S67  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nmetastatic renal tumours, at least for certain tumour types, and may help as \nneoadjuvant phases before ablation.  \nSession Objectives: \n1. To learn about the actual capabilities of imaging for characterising renal \ntumours. \n2. To become familiar with emerging therapeutic strategies. \n3. To understand the imaging requirements for staging metastatic tumours and \nmonitoring new treatments. \nA-295 16:05 \nCharacterising solid renal tumours in 2014: from morphology to function  \nN. Grenier, F. Cornelis; Bordeaux/FR (nicolas.grenier@chu-bordeaux.fr) \nCharacterising tumours before deciding on the most appropriate treatment is a \ngeneral rule in oncology. Cystic tumours are now adequately graded based on \nBosniak's classification. However, this pre-therapeutic characterisation is not \ncurrently systematic in case of solid renal tumours, as it remains difficult in \nclinical practice due to the high prevalence of renal cell carcinomas (RCC) and \nthe lack of reliable imaging criteria for recognition of benign versus malignant \ntumours. As a result, approximately 10% to 20% of surgically excised renal \nmasses are actually benign. To avoid these unnecessary ablations, pre-\ntherapeutic image-guided biopsy has been proposed, but its use is still debated \nas it is invasive and time consuming. New validated imaging criteria, able to \naccurately differentiate the most common tumour types but also indolent vs \nmore aggressive malignant lesions, would be useful to reduce the number of \nunnecessary biopsies or to consider the most appropriate treatment for a \ntumour or active surveillance. Among these, MR imaging plays a major role \nbased on chemical shift gradient echo (GRE) sequences, signal intensity on \nT2-weighted images, dynamic contrast-enhanced sequences, diffusion-\nweighted sequences and late contrast-enhanced images. Multiparametric MR \nimaging is now performed in clinical practice in most primary care centres. \nTherefore, using different combinations of two or several parameters, it is now \npossible to distinguish cert ain renal tumours. A larger validation of all these \ncombinations is still necessary to define those having a clinical significance for \nroutine practice.  \nLearning Objectives:\n1. To learn about the capabilities of multiparametric imaging for \ncharacterisation of tumours. \n2. To understand the impact of characterisation on biopsy strategies. \n3. To become familiar with functional techniques applied to renal tumours. \nA-296 16:25 \nNew therapeutic approaches for localised renal tumours: the urologist's \nopinion  \nJ.-J. Patard; Le Kremlin-Bicêtre/FR (jean-jacques.patard@bct.aphp.fr) \nThe widespread use of modern imaging has led to increased detection of \nsmall, low-stage, low-grade renal tumours. In this setting, partial nephrectomy \n(PN) has progressively emerged as a standard of care. PN was first used in \nabsolute indications (solitary kidneys, bilateral tumours, renal chronic disease) \nand thereafter in elective cases for tumours measuring less than 4 cm. \nNowadays, PN is recommended for all T1 tumours, because perhaps it is \ntechnically feasible and the negative margins can be safely obtained. In \nparallel, PN modalities have evolved from open to laparoscopic and now \nrobotic-assisted approach. Robotic PN combines the advantages of open \n(short ischaemic time) and laparoscopic PN approaches (low morbidity, \nreduced postoperative pain, short hospital stay). In the meantime, reliable \nanatomical classifications have helped urologists to predict PN complexity and \npostoperative morbidity. The use of ablative treatment was first restricted to \npatients who were not suitable for or who refused surgical treatment. The \nadvantages of these mini-invasive treatments compared to PN are: possibility \nof an outcome procedure, percutaneous approach, minimal nephron damage, \nvery low morbidity and the possibility of repeated treatments. The current \nindications include: small cortical tumours ( \u00013 cm) in aged people with \nsignificant life expectancy, inherited renal or bilateral tumours and solitary \nkidney. Obtaining histology by percutaneous biopsy before treatment is \nrecommended. Finally, the current indication s for active surveillance include: \npatients > 75 years with multiple and severe comorbidities, renal mass Ø \n< 4 cm, incidental diagnosis and acceptance for repeated imaging.  \nLearning Objectives:\n1. To learn about expansion and the limitations of conservative surgery. \n2. To become familiar with actual indications of percutaneous image-guided \nablations. \n3. To learn about application of an active surveillance strategy to renal \ntumours. \nA-297 16:45 \nImpact of imaging in targeted therapy of metastatic renal cancer: the \noncologist's opinion  \nA. Ravaud; Bordeaux/FR (alain.ravaud@chu-bordeaux.fr) \nTargeted therapies such as VEGF mAb bevacizumab, VEGF tyrosine kinase \ninhibitors (sunitinib, pazopanib, axitinib and sorafenib) and mTOR inhibitors \n(temsirolimus and everolimus) have been approved and included in European \nguidelines. Pre-therapeutic imaging prerequisites are mainly based on the \nnatural history of MRCC. This justifies imaging through a thoracoabdominal CT \nscan. Outside clinical symptoms, there is no need for bone imaging or brain CT \nscan; the latter nevertheless could be done because of influencing the \ntherapeutic strategy. PET scan should not be done due to low sensitivity. The \nevolution of metastatic sites by comparison from previous imaging is useful to \nevaluate the natural history. Outside c linical trials or research imput the \nstrategy is to use the drug in an optimal way to increase PFS. So far, \nmonitoring has to inform about change in RECIST criteria for CR, PR, SD or \nPD, and if PD is a real PD such as RECIST PD or a slowing PD. In conclusion, \nstandard CT scan and RECIST are adapted to real life. Nevertheless, more \ninformation on the mode of action of targeted drugs should be interesting for \nknowledge and research purpose, without any impact on the management of \npatients. Additional imaging could be done with additional criteria than RECIST \non CT scan, by vascular functional imaging and PET scan.  \nLearning Objectives:\n1. To learn about new targeted drugs for metastatic renal cancer. \n2. To understand the pre-therapeutic imaging prerequisites. \n3. To learn about the role of imaging for monitoring treatments. \nAuthor Disclosure:\n A. Ravaud: Advisory Board; Member of Global, European and/or French \nboards in renal cell tumor for Pfizer, Novartis, Bayer, GSK, Aveo, Astellas, \nBMS. Investigator; international PI for study for Pfizer, Novartis; steering \ncommitte for trials for Pfizer, Novartis, BMS. Research/Grant Support; \ninstitutional grant support by Pfozer, Novartis, Roche. Other; Travelling and \nhousing suppport for meetings by Pfizer, Novartis. \nCase presentation and discussion  \n17:05\n16:00 - 17:30 Room F1  \nBreast  \nRC 1102  \nClinical challenges in breast MRI  \nA-298 16:00 \nChairman's introduction  \nF.J. Gilbert; Cambridge/UK (fjg28@cam.ac.uk) \nBreast MRI is recognised as a useful tool for a number of clinical indications, \nbut remains relatively challenging. Recognising the importance of an evidence-\nbased approach to the development of protocols will influence the further \nintegration of this technique into everyday clinical practice in the management \nof breast cancer patients. There remain concerns regarding the potential of \nover-diagnosis from breast MRI. The aim of this integrated RC is to inform the \nclinical practice with regard to the establishment of breast MRI in specific \nclinical and imaging scenarios, namely, using MRI for surveillance in high-risk \npatients, monitoring response to neo-adjuvant chemotherapy and developing \nprotocols for the indeterminate imaging scenario of non-mass-like \nenhancement. The establishment of protocols to maximise the specificity and \nsensitivity of the technique of breast MRI in such indeterminate clinical and \nimaging scenarios will be discussed.  \nAuthor Disclosure:\n F.J. Gilbert: Speaker; Bracco. \nA-299 16:05 \nA. High-risk patients: establishing clinical protocols  \nJ. Veltman; Almelo/NL (j.veltman@zgt.nl) \nContrast-enhanced MRI has, especially in younger women with dense breasts, \na superior sensitivity for detecting breast cancer. Young women usually do not \nneed screening unless they have an increased risk for developing breast \ncancer. An increased risk can be based on a positive familial history or on a \nproven gene mutation. The BRCA1 and BRCA2 gene mutations are the most \nwell known related to an increased breast cancer risk. In this group, false-\nnegative rates up to 62% have been reported for mammography. Several \npapers have demonstrated the value of contrast-enhanced MRI in high-risk \nscreening for early detection and even demonstrated a more favourable lymph \nnode status for these women. An upcoming MRI technique for detecting and \nclassifying breast lesions is diffusion -weighted imaging (DWI). The main \n\nA B C D E F G S68  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nadvantages of DWI are the short examination time and that no contrast is \nneeded. In literature, DWI has demonstrated great diagnostic potential. \nEspecially high sensitivities have been reported (80%-97.8%). The high \nsensitivity values reported give DW I the potential to become a fast, non-\ncontrast, and therefore relatively cheap, highly sensitive screening technique. \nThe specificity and spatial resolution are however still moderate. At this point, \ncontrast-enhanced MRI is the best available modality for the detection of \nbreast cancer in women with an increased risk. The detection of smaller \nlesions, patient anxiety, the often benign morphologic characteristics seen in \ncancers and the often aggressive nature of breast cancer in young women \nshould lower the threshold for MRI-guided-biopsies.  \nLearning Objectives:\n1. To become familiar with the literature on the role of breast MRI in screening \nof high-risk patients. \n2. To understand current protocols in clinical practice. \n3. To appreciate the challenges of breast MRI imaging in this patient group. \nAuthor Disclosure:\n J. Veltman: Advisory Board; Hologic. \nA-300 16:28 \nB. Non-mass like enhancement (NMLE): when to biopsy?  \nC.K. Kuhl; Aachen/DE (ckuhl@ukaachen.de) \nNon-mass like enhancement is a frequent finding in breast MRI. It relates to \nthe fact that enhancement occurs in the normal-appearing fibroglandular tissue \nthat surpasses that of the other parts of the parenchyma. There is no \nassociated space-occupying lesion. In pre-contrast non-fat-suppressed or fat-\nsuppressed T1- and T2-weighted images, there is usually no correlate \nobservable. The differential diagnosis of non-mass-like enhancement is \nbetween benign nonspecific fibrocystic disease/adenosis, hormonal \nstimulation, and subclinical  mastitis on one hand, vs DCIS or (less likely) \ndiffusely infiltrating (usually lobular) cancer on the other. Key components of \ndifferential diagnosis is configuration of the enhancement (does it follow the \norientation of the milk duct or not?) and symmetry (symmetric or asymmetric). \nLess important criteria are internal enhancement (internal architecture) and \nenhancement kinetics. It is important to realise that enhancement kinetics can \nonly be used to corroborate the suspicion of DCIS - but they cannot be used to \nalleviate the indication to biopsy a fi nding which, based on configuration and \nasymmetry, is suspicious. Management depends on the different constellation \nof clinical, mammographic, and MRI findi ngs. It usually includes short-term \nfollow-up (6 months) and, if stable/persistent, MR guided vacuum biopsy.  \nLearning Objectives:\n1. To learn about the clinical significance of NMLE. \n2. To understand differential diagnosis for NMLE. \n3. To become familiar with a work-up algorithm of NMLE cases. \nA-301 16:51 \nC. Monitoring response to neo-adjuvant chemotherapy  \nT.H. Helbich; Vienna/AT (Thomas.Helbich@meduniwien.ac.at) \nAssessment of the change in tumour burden is an important feature of the \nclinical evaluation of cancer therapeu tics. Tumour shrinkage and time to the \ndevelopment of disease progression are important end points in cancer clinical \ntrials. However, these end points are useful only if based on widely accepted \nand readily applied standard criteria. Criteria, known as RECIST, were \npublished and are updated on a regular base. The revised RECIST includes a \nnew imaging appendix and underlines the importance of moving from anatomic \nunidimensional assessment to either volumetric anatomical assessment or \nfunctional assessment with PET or MRI. The goal of the lecture is to discuss \nthe value of the different MR imaging techniques (e.g. MR spectroscopy, \ndiffusion-weighted imaging, angiogenesis mapping, PET-MRI), which evaluate \nresponse to treatment in breast cancer. Participants will learn about particular \nimaging challenges of assessing response to neo-adjuvant chemotherapy. In \naddition, they will learn to understand clinical aspects of neo-adjuvant \nchemotherapy based on RECIST.  \nLearning Objectives:\n1. To understand the clinical aspects of neo-adjuvant chemotherapy. \n2. To appreciate evidence-based protocols for imaging in this clinical setting. \n3. To learn about particular imaging challenges of assessing response to neo-\nadjuvant chemotherapy.\nAuthor Disclosure:\n T.H. Helbich: Advisory Board; Philips. Grant Recipient; Siemens, Guerbet. \nPanel discussion:  \nHow can the specificity and sensitivity of breast MRI in these \nindeterminate clinical and imaging scenarios be maximised?  \n17:14\n16:00 - 17:30 Room F2  \nProfessional Challenges Session  \nPC 11  \nThe role of social media in radiology  \nA-302 16:00 \nChairman's introduction  \nP. Pokieser; Vienna/AT (peter.pokieser@meduniwien.ac.at) \nCurrently, the ESR has been using social media in many successful ways to \nimprove the contacts among members and to boost our fast development as \none of the most advanced scientific communities in the world. Our session \n\"The role of social media in radiology\" presents the view of 4 experts, \nacknowledged leaders of international IT projects. It seems to be important to \ndiscuss the major implications of social medi a for radiology, the leading clinical \ndiscipline in information technology. Davide Caramella will clarify the \nrelationship of social media to professi onal societies and especially to the ESR, \nincluding their basic features. The \"Social media generation\" has developed \nfrom schoolkids to students and, recently, to teachers as well. Alexander \nSachs represents the young professional expert of ELearning in Radiology and \nwill reflect the current user behaviour. Osman Ratib will share his view on how \nsocial networks enhance the communication between radiologists, non-\nradiologists and patients. Critical aspects of the pros and cons of large \ncommunication scenarios are followed by some ideas of future developments. \nJürgen Brandstätter will indicate the patient´s view. Most patients see social \nnetwork communications with their radiologist as useful for, e.g. appointment \nmanagement or other non-sensitive communication. Besides communicating \npersonal health data, a wide area of potential useful other possibilities are at \nhand, like anonymised health data for reviewing purposes, second opinion or \neducation of patients. The fast development of social media may induce hopes \nand fears; the four speakers of this session will present them in a panel \ndiscussion.  \nSession Objectives: \n1. To learn about social networks which are important for the ESR and its \nmembers. \n2. To understand the intentions and motivations behind social networks. \n3. To appreciate the unique services and  opportunities offered by different \ntypes of networks. \n4. To become familiar with the pros and cons of using social networks. \nA-303 16:05 \nMajor social media networks and their relationship to professional \nsocieties  \nD. Caramella; Pisa/IT (davide.caramella@med.unipi.it) \nThe widespread use of social networks in all professional activities has \nattracted a great interest in the recent years. In medical applications, the main \nconcerns include the possible consequences in terms of patients' \nconfidentiality protection, perceived role  of the physician, patient-physician \nrelationship, and caregivers' distracti on during professional activities. There are \nno doubts, however, that social network s are beneficial in enhancing the \ninformation flow between scientific soci eties and their professional members, \nwithout any interference at the point of care. Social networks have proved to be \nextremely effective in updating members about relevant news concerning their \nareas of interests and in allowing them to be informed about the educational \nactivities promoted by their scientifi c societies. This presentation focuses on \nthe social network activities promoted by the ESR via Facebook, YouTube, \nTwitter and other blogs.  \nLearning Objectives:\n1. To learn about the ESR's relations with to social networks. \n2. To understand the basic features of Facebook, YouTube, Twitter and blogs. \n3. To learn about the productive use of ESR networking for its members. \nA-304 16:23 \nImpact of social media on the training of radiologists  \nA. Sachs; Vienna/AT (alexander.sachs@meduniwien.ac.at) \nIn modern times, social media have gained more and more important value in \nexchanging first experiences in radiolog y from resident to resident. Social \nnetworks such as Facebook, Twitter, Google plus and others are used to start \ndiscussion groups about cases and share the growing knowledge with different \neducational concepts in each hospital. Growing e-learning modalities as \nMOOCs, applications for smartphones or tabs and web-based case series or \nlearning platforms support the training of radiologist in social media. Modern e-\nlearning platforms use social media as their first choice of sharing knowledge \naround the whole world about certain illnesses, cases or different decisions of \ntherapy. Though sharing information seems to be easier and shows several \n\nA B C D E F G S69  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nadvantages than in former times, social  media can also highlight new \nproblems. This lecture focuses on user behaviour to improve learning, the \npedagogic evidence for large group learning with networks and the importance \nof using networks to manage time.  \nLearning Objectives:\n1. To learn about the current user behaviour of ESR members in order to \nimprove learning. \n2. To learn about paedagogic evidence for large group learning with networks. \n3. To appreciate the importance of using networks to manage time. \nA-305 16:41 \nSocial media networks in communication between radiologists, non-\nradiologists and patients  \nO. Ratib; Geneva/CH \nWhile social networks have gained unprecedented popularity in our daily \nenvironment, they have only limited utilisation in medical applications. The \nparadigm of communication within a given community for exchange and \nsharing of imaging data would certainly have its place in a medical \nenvironment where there is an increasing need for multidisciplinary \ncollaborative work. The required security and confidentiality in management of \nsensitive patient data have often precluded th e usage of existing public social \nnetworks. Professional proprietary systems have emerged in a more restricted \nway with much less flexibility leading to limited use. The exchange of medical \nimages adds a level of complexity due both to the size of the data and the \nneed for appropriate browsing and visualisation tools. Traditional PACS and \nteleradiology system offer such features, but in a very limited way, far from the \ndesired convenience of social networking between groups of users. A \nprototype of such a system aimed essentially at the community of users that \nneed to exchange anonymised medical images and data for academic and \nresearch purposes will be presented and discussed. The project nicknamed \nDICOM SandBox is being tested and evaluated by some users in Europe \nunder the coordination of the ESR subcommittee of eHealth and informatics. \nDeveloped with Open Source software components, it allows using existing \ncloud-based storage services with additi onal layers of secure DICOM file \nmanagement and visualisation. It allows the community of users to share \nDICOM data with all social networking and notification features beyond simple \npeer-to-peer exchange.  \nLearning Objectives:\n1. To appreciate how social networks enhance communication between \nradiologists, non-radiologists and patients. \n2. To appreciate the pros and cons of large communication scenarios. \n3. To learn about the future of social networks. \nA-306 16:59 \nInteractions between patients and radiologists through social media  \nJ. Brandstätter; Wiener Neudorf/AT (j.brandstaetter@codewerk.at) \nSocial networks have become integral parts of most citizen's use of the \nInternet. Especially, the younger generation uses social networks extensively; \nhowever the way those tools are used should be chosen carefully. It is one \nthing to use a social network for private interests, but a different one to use it \nas transport media for sensible data like personal health-care data. The \nsensitiveness of citizens regarding privacy has been increased recently by \ndifferent events of misuse or fraud, especially accelerated by the recent privacy \naffairs caused by governmental agencies. Though most patients see social \nnetwork communications with their r adiologist useful for, e.g. appointment \nmanagement or other non-sensitive co mmunication, personal medical reports \nor images shall not be shared across this media. Besides communicating \npersonal health data, a wide area of potential useful other possibilities are at \nhand (e.g. anonymised health data for reviewing purposes, second opinion, \neducation of patients, …). Future developments shall make use of social media \nwhere useful, but always with deep respect to the patient's privacy rights.  \nLearning Objectives:\n1. To learn to appreciate the patient's view. \n2. To understand what patients demand from radiologists in social network \ncommunications. \n3. To become familiar with the patient's view of future developments. \nPanel discussion: Social networks: hopes and fears  \n17:17\n16:00 - 17:30 Room G/H  \nNeuro  \nRC 1111  \nBrain tumours: the central role of \nradiology  \nA-307 16:00 \nChairman's introduction  \nM.A. Lucic; Sremska Kamenica/RS (milos.a.lucic@gmail.com) \nApart from the historical, but ever present clinical expectation from the \nneuroradiologist is the answer to the most important question if the patient has \na brain tumour or not. Nowadays, due to the outstanding technological \nadvances in imaging techniques during the last decades, the stakes are \ngrowing much higher and it is the neuroradiologist on whom lies the initial \nresponsibility of answering a large number of questions that are of utmost \nimportance for further brain tumour patient care and treatment. Having the \nopportunity to provide the usual and generally basic information regarding \ntumour morphology and exact location and to narrow the differential diagnostic \npossibilities, neuroradiologic expertise now opens a wide spectrum of \ntechniques, especially those derived from MRI, such as MR spectroscopy, MR \nperfusion, DWI, DTI, SWI, etc. These provide us the unique possibility of not \nonly obtaining and comparing images, but also of exploring multiparametric \nbrain maps, allowing us to gain insight into the internal architecture of the \ntumour and the functional and molecular features of the tumorous tissue. This \nconsequently defines the actual stand of ne uroradiology, indicating the uprising \nclinical urge not only to provide the answers regarding the tumour type, grade \nand possibilities of the most appropriate and patient-individualised therapy \nmodality, whether surgical or nonsurgical, but also to accurately assess the \npost-treatment tumour behaviour and status, by differentiating the true tumour \nprogression from pseudoprogression, represented by inflammatory responses \nto the radio- and/or chemotherapeutical treatment, and to monitor other \nneurooncological response assessment criteria.  \nA-308 16:05 \nA. Differential diagnosis and pseudo-tumoural lesions  \nH.R. Jäger; London/UK (r.jager@ucl.ac.uk) \nConventional contrast-enhanced MR imaging gives an indication about the \nlikely tumour type and histological grade, but advanced MR imaging methods, \nincluding perfusion-weighted (PWI) and diffusion-weighted (DWI) imaging, MR \nspectroscopy (MRS) and PET imaging provide additional information which \nhelps to refine the diagnosis of intrinsic brain tumours. Contrast enhancement \ncan be a feature of low-grade (pilocytic astrocytoma and ganglioneuromas) as \nwell as high-grade gliomas (WHO grade III anaplastic gliomas and WHO grade \nIV glioblastomas). Infiltrative low-grade (WHO grade II) astrocytomas do not \nusually enhance, whereas WHO grade II oligodendrogliomas can enhance. \nHigher-grade glial tumours (WHO grade III and IV) tend to have an elevated \nrelative cerebral blood volume (rCBV) on PWI, a decreased ADC on DWI and \nincreased choline turnover on MRS and PET imaging. A raised rCBV can, \nhowever, also be seen in low-grade oligodendrogliomas, particularly in those \nwith a 1p/19q chromosomal translocation, which is associated with a better \nresponse to chemotherapy. PWI and DWI are useful in the differentiation of \nglial neoplasms from cerebral lymphoma, which has an increasing incidence in \nthe immuno-competent population. DWI and PWI are also very useful in the \ndifferentiation of enhancing pseudo-tumoural lesion such as cerebral \nabscesses, tumefactive demyelination, pseudoprogression and radiation \nnecrosis.  \nLearning Objectives:\n1. To appreciate the differential diagnosis of tumoural lesions in the diagnostic \nsetting. \n2. To learn how to differentiate between tumoural and non-tumoural disease \nusing DWI. \n3. To consolidate knowledge on how to combine DWI with other advanced MRI \ntools. \nA-309 16:28 \nB. Grading and prognosis: role of perfusion imaging  \nY. Özsunar; Aydin/TR (yeldaozsunar@gmail.com) \nPerfusion imaging plays an important role in the characterisation and \nmanagement of brain tumours. Low-grade brain tumours may transform into \nhigh-grade gliomas at some point, which is a transformation that is highly \nvariable and difficult to predict in an in dividual patient. Conventional contrast-\nenhanced computed tomography (CT) and magnetic resonance (MR) imaging \nare found to be insufficient to depict this transformation and angiogenesis and \n\nA B C D E F G S70  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\ntherefore to detect malignancy. However, perfusion imaging provides additional \ninformation over conventional imaging in terms of tumour physiology and \nhaemodynamics, providing important biomarkers for malignancy and \nprognosis. Perfusion CT and MR perfusion techniques such as arteriel spin \nlabelling and dynamic susceptibility-weighted perfusion imaging are more \npractical and widely used compared to nuclear medicine methods. These \nperfusion techniques should be considered and used in routine clinical workup \nof brain tumours to asses grading and prognosis.  \nLearning Objectives:\n1. To understand why perfusion imaging is routinely needed for brain tumours. \n2. To become familiar with principles, applications, and pitfalls of various \nperfusion imaging techniques. \n3. To consolidate knowledge of perfusion imaging for various brain masses \nthat can be encountered in daily practice. \nAuthor Disclosure:\n Y. Özsunar: Research/Grant Support; funding from Adnan Menderes \nUniversity Research Funding Programme. \nA-310 16:51 \nC. Monitoring treatment: real or pseudo progression?  \nP.C. Maly Sundgren; Lund/SE (Pia.Sundgren@med.lu.se) \nMaximal safe resection, radiation therapy and temozolomide chemotherapy are \nthe current standard of care for newly diagnosed high-grade gliomas. Still, \nHGG have a poor survival rate. A contributing factor to the poor survival is the \ninability of currently available imaging techniques to accurately delineate the \ntumour, with the result that targeted focal treatment my not be effective. \nConventional imaging is not able to give an early assessment of the \neffectiveness of radiation and/or chemoth erapy. In addition, conventional \nimaging has difficulties in differentiating pseudo-progression, which is a \ncommon phenomenon in conventional chemo-radiation therapy, from true \nprogression. Early identification of patients who suffer from tumour recurrence \ncan be of great advantage: it provides the opportunity to adjust individuals \nmore rapidly, sparing patients unnecessary morbidity and delay in the initiation \nof other, maybe more effective, treatment. In recent years, different functional \nimaging approaches such as perfusion MRI, diffusion-weighted imaging and \nspectroscopy, have been complementarily used for imaging evaluation of \ntreatment response. In this lecture, different advanced MR and CT imaging \nmethods used to support differentiation between pseudo-progression and true \ntumour progression to assess treatment response will be discussed. In \naddition, a novel recently published promising technique, the parametric \nresponse mapping (PRM), a novel voxel-wise analytical method of monitoring \nphysiological and environmental changes in a tumour volume during treatment \nwill be presented and compared to the traditional methods used. Finally, the \naim of the lecture is to consolidate the present knowledge and novel ideas in \nbrain tumour imaging for assessment of pseudo-progression versus true \ntumour progression.  \nLearning Objectives:\n1. To understand the challenges and limitations of routine MRI in monitoring \nbrain tumour treatment. \n2. To become familiar with the role of advanced imaging biomarkers for early \nassessment of treatment response. \n3. To learn how to integrate routine and advance MRI into clinical practice after \ntumour therapy. \nPanel discussion:  \nWhat is the optimal role of radiology in a tumour  \nboard session?  \n17:14\n16:00 - 17:30 Room I/K  \nHead and Neck Imaging  \nCC 1119  \nHow to perform and read a head and neck \nstudy (part 2)  \nModerator:  \nS. Bisdas; Tübingen/DE \nA-311 16:00 \nA. CT and MR perfusion study of the head and neck  \nK. Šurlan Popovi\u0007; Ljubljana/SI (katarina.surlan@kclj.si)\nThe purpose of this lecture is to describe the role of functional radiological \nimaging modality-CT and MR perfusion in the evaluation of head and neck \ntumors. Conventional contrast-enhanced CT and/or MR imaging are the \ncurrent standard techniques for the diagnosis and treatment evaluation of the \nhead and neck tumors. However, this method is limited in its ability to depict \nthe angiogenesis which is a hall-mark of tumor growth. Perfusion imaging \nprovides a rapid evaluation of tissue perfusion and can be easily implemented \nin every head and neck CT or MR protocol. The determination of tissue \nperfusion is based on examining the relationships between the arterial, tissue \nand potentially the venous enhancement after the introduction of a bolus of \ncontrast material. The quantification of the perfusion values helps to outline the \nmalignant tissue as well as to differentiate recurrent disease from nonspecific \npost-therapeutic changes and can be used as a therapeutic monitoring tool \nduring and after tumor therapy. \nLearning Objectives:\n1. To learn how to perform proper CT/MR perfusion. \n2. To learn how to interpret the results. \n3. To understand which clinical and diagnostic dilemmas can be addressed \nwith this technique. \nA-312 16:30 \nB. MR diffusion study and how to interpret it  \nH.C. Thoeny; Berne/CH (harriet.thoeny@insel.ch) \nIn recent years diffusion-weighted MRI (DWI) gained increasing importance \nand also acceptance in head and neck radiology. Although this functional \ntechnique is challenging due to air tissue interfaces, its ability to improve the \ndiagnostic accuracy is widely accepted. DWI can be applied to detect lesions \nnot only in adults, but also in children. It is helpful in lesion characterisation and \nhas a great potential to differentiate recurrence from posttherapeutic changes. \nInitial promising results to improve lymph node staging however are difficult to \nreproduce. Image interpretation is performed qualitatively based on visual \nassessment of the high b-value images (b= 800-1000sec/mm\n2) and the \ncorresponding apparent diffusion coeffi cient (ADC) map. Quantitative image \nanalysis is based on the measurement of the underlying ADC value. Solid \ntumors including recurrences are bright on the high b-value images and dark \non the corresponding ADC map, whereas posttherapeutic changes are bight \non both the high b-value images as well as the ADC map. Cystic and necrotic \nlesions are typically dark on the high b-value image and bright on the ADC \nmap. Furthermore, malignant lesions tend to have a lower ADC compared to \nbenign and cystic lesions provided that no necrosis is present. Therefore, \nimage interpretation always has to be performed together with morphological \nimages to avoid misinterpretation of functional images.  \nLearning Objectives:\n1. To learn the technique and learn how to perform MR diffusion successfully. \n2. To learn how to interpret the results. \n3. To appreciate the pitfalls and advantages of this method. \nA-313 17:00 \nC. PET/CT and MR/PET: the true added value of the method  \nM. Becker; Geneva/CH \nPET/CT has established itself as a robust, rapid and reliable technique in head \nand neck oncology. It is mainly used to stage nodal disease, to detect distant \nmetastases and synchronous tumours, to identify unknown primary tumours in \npatients with metastatic neck nodes, to assess treatment response and \nprognosis after chemoradiotherapy and for radiotherapy planning. MRI with \ndiffusion-weighted imaging (DWI) is routinely used for the assessment of \nsubmucosal tumour spread, to stage nodal disease, to monitor treatment \nresponse and to detect recurrent disease. The information provided by PET/CT \nand MRI is often complementary and the recent implementation of hybrid \nMR/PET systems in clinical settings holds promise because it can combine \nmorphologic, functional and molecular information. This lecture focuses on \nclinical applications of PET/CT and MR/PET in the head and neck. Current \nevidence about the combined use of PET/CT and MRI with DWI is discussed. \nThe principles of MR/PET data fusion are summarised as well as current \nknowledge regarding the diagnostic performance of MR/PET in the head and \nneck. Typical radiologic findings of tumour manifestations are reviewed with \nparticular emphasis on the early detection of lesions, their appearance on \ndifferent imaging modalities and the added value of hybrid imaging techniques. \nThe variable appearance of functional phenomena mimicking disease as well \nas the potential pitfalls of image interpretation and how to avoid them are \nequally addressed. Major emphasis will be put on how to report the findings in \na comprehensive way.  \nLearning Objectives:\n1. To learn what additional information is acquired by PET. \n2. To appreciate the clinical importance of this examination. \n3. To learn how to interpret results and avoid mistakes. \n\nA B C D E F G S71  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n16:00 - 17:30 Room L/M  \nPhysics in Radiology  \nRC 1113  \nNovel developments in CT and their \nimpact on dose  \nModerators:  \nW. Stiller; Heidelberg/DE \nA.J. van der Molen; Leiden/NL \nA-314 16:00 \nA. Impact of CT on patient dose  \nR. Bly; Helsinki/FI (ritva.bly@stuk.fi) \nMethods to assess patient dose from CT and its importance for collective \neffective dose to population (population dose) will be presented. Patient dose \nfrom CT as an effective dose can be estimated using technical dose \nparameters, such as dose length product (DLP) and CT dose index (CTDI) and \nconversion factors. Technical dose parameters can also be used to define \ndiagnostic reference values (DRL) that are used as a tool for assessing if CT \nprocedures are optimised. Population doses from radiodiagnostic procedures \nin Europe were estimated for the first time in the recent DOSE DATAMED 2 \n(DDM2) project (www.ddmed.eu) launched by the European Commission. \nExamples of calculation procedures for CT dose will be presented. Typical \neffective doses for some procedures will be presented as well as existing DRLs \nin Europe. The estimated population dose per caput in Europe is 1 mSv, which \nis lower than the corresponding dose in the USA (3 mSv) or Australia (1.7 \nmSv). The highest average contribution is from CT, 56 %. There are high \nvariations between countries in frequencies and typical effective doses. This \npresentation will review the available data in European countries using graphs.  \nLearning Objectives:\n1. To learn about the European-wide DoseDataMed2 survey. \n2. To understand the impact of CT practice on population exposure. \n3. To understand the role of diagnostic reference levels in CT. \nA-315 16:30 \nB. New frontiers in CT: functional and spectral imaging  \nA. Persson; Linköping/SE (anders.persson@cmiv.liu.se) \nMulti-energy and functional imaging CT has reached a robustness allowing the \nuse of this new technology in clinical routine for a variety of different clinical \nquestions. This presentation will discuss the basic principles and the strengths \nand limitations of the techniques. Implementations of multi-energy methods for \nmaterial characterisation and of CT methods for functional imaging will be \ndiscussed. Contrary to normal single-energy CT systems, multi-energy CT \nscanners allow simultaneous scanning at two peak X-ray energies. When the \nattenuation is measured at two energies, their values are not exactly \nproportional to each other, which open new diagnostic possibilities. \nMeasurements at two spectra can be achieved using multiple kVp and/or \nfiltration or with detectors with energy discrimination. These methods have \ndifferent pros and cons such as sensiti vity to subject motion and dose \nefficiency. To be able to acquire functional data such as perfusion, images are \nacquired dynamically following the injection of a contrast agent and \nphysiological models are used to convert the measured contrast agent \nconcentration to perfusion estimates. Methods that acquire multiple images \nhave the potential to increase the radiation dose to the patient, so CT protocols \nneed to be optimised.  \nLearning Objectives:\n1. To learn about new developments in functional and spectral CT imaging. \n2. To appreciate the impact on patient dose. \nA-316 17:00 \nC. New image reconstruction techniques  \nJ. Sijbers; Antwerp/BE (jan.sijbers@ua.ac.be) \nIn computed tomography, 3D images are reconstructed from a number of x-ray \nradiographs that were acquired at different angles. Tomographic reconstruction \nrelates to the generation of a 3D image based on these acquired radiographs. \nMost tomographic reconstruction methods are based on a technique called \nfiltered back projection (FBP) in which a sharpened version of the radiographs \nare back projected to generate the 3D image. While it has been the standard \nreconstruction method, mostly due to its speed and good quality if many \nradiographs are available, iterative reconstruction methods are emerging. The \nreason for that is that FBP suffers from important disadvantages. In this talk, \nthe basic concepts of iterative reconstruction are explained and its virtues are \ndetailed. The flexibility of iterative reconstruction methods is demonstrated for \nthe field of x-ray computed tomography. Finally an outlook is given with respect \nto future research on tomographic reconstruction.  \nLearning Objectives:\n1. To understand the principles of iterative reconstruction techniques in CT. \n2. To learn about advances in iterative reconstruction algorithms. \n3. To appreciate the impact on patient dose. \n16:00 - 17:30 Room N/O  \nInterventional Radiology  \nRC 1109  \nGynaecological and obstetrical \nhaemorrhagic emergencies  \nA-317 16:00 \nChairman's introduction  \nA.-M. Belli; London/UK (Anna.Belli@stgeorges.nhs.uk) \nInterventional radiology (IR) has been increasingly applied in the management \nof obstetric and gynaecological haemorrhage. National reviews of maternal \ndeaths from post-partum haemorrhage have recognised that maternal deaths \nmay be prevented by IR and that all obstetric units should have protocols and \narrangements in place to ensure appropriate and timely referral to IR. The \nimportant role that IRs play in the management of fibroids has also highlighted \nhow these techniques can be applied to other gynaecological conditions which \nmay result in haemorrhage. This session will start by describing which \ngynaecological disorders may result in  haemorrhage and the technical aspects \nof treatment followed by the published evidence for embolisation. The session \nwill then focus on obstetric haemorrhage, with an emphasis on prophylaxis and \nhow women deemed at high risk for haemorrhage might be managed safely. \nThe techniques used for prophylaxis of haemorrhage will be described in detail \nand the published data presented. The final presentation will concentrate on \nthe technical aspects of embolisation when haemorrhage has occurred to \nensure the best results by knowing the relevant anatomy and appropriate \ntechnique of embolisation. The published evidence of the results of \nembolisation in PPH will be presented. These presentations will be followed by \na panel discussion on how IRs can reduce the radiation dose whilst \nsimultaneously ensuring successful outcomes for their therapies, an important \nissue in a young and fertile group of women.  \nAuthor Disclosure:\n A.-M. Belli: Advisory Board; Boston Scientific. Investigator; Covidien, \nEurocor, Bayer. \nA-318 16:05 \nA. Etiology and treatment of benign and malignant gynaecological \ncauses of massive bleeding  \nO. Pellerin; Paris/FR (olivier.pellerin@egp.aphp.fr) \nGynaecologic massive bleeding related to benign and malignant causes is \nunder the scope of all radiologists because of being diagnostic and also \nbecause of its implication in interventional radiology procedures. The causes \nare uterine fibroids (UF) and post-partum hemorrhage (PPH). However, \noncologic disease, arterio-venous abnormalities, or iatrogenic injuries are less \ncommonly known to be eligible for embolisation procedures. Usually, surgical \nhomeostasis attempts or radical hysterectomy is preferred to embolisation \nprocedures. Despite the good clinical outcome for hysterectomy and the \nhazardous success rate of conservative treatment, both are unsatisfactory to \npatients. Pelvic artery embolisation (PAE) could dramatically change the \npatients' clinical issue. The purposes of this lecture are to: revise the pelvic \narterial anatomy (possible arterial anastomosis or variation); outline the \naetiology of non-obstetric massive menometrorrhagia; expose the typical \nclinical presenting features; describe the imaging appearances of the \netiologies; and discuss patient secti on, procedure technique, pitfalls and \ncomplications.  \nLearning Objectives:\n1. To learn more about causes of massive bleeding due to gynaecological \ndisorders. \n2. To learn about diagnostic imaging and therapeutic embolisation. \n3. To learn about published results obtained through embolisation. \nA-319 16:28 \nB. Can we prevent post-partum haemorrhage  \nJ.K. Gupta; Birmingham/UK (j.k.gupta@bham.ac.uk) \nIn my lecture, I shall identify a patient at risk for post-partum haemorrhage and \nthe obstetric complications that can arise as a result. I shall indicate how to \nbecome familiar with preventive measures and medication, and discuss more \n\nA B C D E F G S72  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nabout techniques for invasive prevention and the role of uterine artery \nembolisation as a possible preventive technique  \nLearning Objectives:\n1. To learn how to identify a high-risk patient. \n2. To become familiar with preventive measures and medication. \n3. To learn more about techniques for invasive prevention. \n4. To learn about the results obtained through preventive techniques. \nA-320 16:51 \nC. Treatment of post-partum haemorrhage  \nA. Krajina, I. Kalousek; Hradec Králové/CZ (antonin.krajina@fnhk.cz) \nObstetric haemorrhage occurring mainly in the postpartum period is a \nsignificant cause of maternal morbidity and death. Blood loss of over 500 and \n1000 ml after vaginal delivery or caesarean section, respectively, complicates \n4% of deliveries. Major blood loss of more than 1000 ml occurs following less \nthan 1% of all deliveries. The causes include uterine atony, retained placenta \nproducts, placental abnormalities, uterine rupture, lower genital tract laceration, \ncervical ectopic pregnancy and coagulopathies. Generally, treatment is based \non administration of uterotonic drugs, vaginal packing, surgical ligation of \nuterine arteries and even hysterectomy is sometimes needed. Transcatheter \nembolisation of uterine, pudendal, vaginal arteries and ovaries is considered to \nbe superior and should be the first-line treatment for intractable obstetric \nhaemorrhage where interventional radiology is available. Angiography reveals \nextravasation of contrast agent in more than 50% of these patients. The most \nfrequent extravasation is from vaginal artery, and then from pudendal and \nuterine arteries. Depending on the extravasation location and haemodynamic \nstability of a patient, 5 F catheters or coaxial microcatheter technique is utilised \nfor catheterisation. Gelatin foam, microparticles acrylic glue and microcoils are \nthe most frequent embolic agents. The embolisation procedure usually does \nnot require general anaesthesia and can be repeated if bleeding continues. \nPrimary success rate in bleeding control is reported from 80 to 90 %. The most \ncommonly reported long-term side effects after embolisation were transient \nbuttock numbness and urinary frequency. The transcatheter pelvic artery \nembolisation for obstetric intractable bleeding is a fertility-preserving alternative \nto hysterectomy.  \nLearning Objectives:\n1. To learn about clinical evaluation of post-partum haemorrhage. \n2. To become familiar with relevant anatomy. \n3. To understand catheterisation and embolisation techniques. \n4. To become familiar with results of embolisation. \nPanel discussion:  \nHow can radiation doses be reduced during treatment?\n17:14 \n16:00 - 17:30 Conf. Room M3  \nHead and Neck  \nRC 1108  \nSkull base lesions: imaging studies and \ndifferential diagnosis  \nModerator:  \nS. Kösling; Halle a.d. Saale/DE \nA-321 16:00 \nA. Anterior cranial fossa with special emphasis on olfactory apparatus \nlesions  \nT.P.J. Duprez; Brussels/BE (thierry.duprez@uclouvain.be) \nMedical imaging has nowadays integrated the diagnostic armamentarium of \nanosmic patients regarding not only qualitative assessment of the olfactory \ntract, but also quantitative evaluati on of olfactory bulb volumes which are \nknown to closely correlate to the olfactory function. Many clinical studies on \nvarious pathological conditions have evidenced the value of such \nmeasurements in the workup of olfactory dysfunction for both aetiologic and \nprognostic purposes. Imaging workup also plays a role in the medico-legal \nevaluation of post-traumatic anosmia together with electrophysiological and \nclinical olfactory tests. Technical im provements in fibre tracking (FT) using \ndiffusion-tensor imaging (DTI) and appropriate designs of olfactory stimulation \nat BOLD-based functional MRI (fMRI) are expected to allow insights into the \nneurophysiological processes and circuitry of olfaction in the very near future. \nImaging workup of the anosmic patients will be the cornerstone of this lecture. \nThe relevance of the different imaging techniques will be detailed. Beyond the \nworkup of anosmia, a comprehensive overview of the most common lesions of \nthe olfactory tract seen in clinical prac tice will be given. Additional review of \nlesions observed at the anterior cranial fossa in the near vicinity of the olfactory \ntract will be done, which comprehensively includes all commonly observed \ndevelopmental, traumatic, inflammatory and neoplastic conditions not arising \nfrom the olfactory tract. Their potential  impact on the olfactory function or on \nother sensory/neurological functions will be underlined. Clues to \nclinical/radiological differential di agnoses of the most common conditions and \nradiological features of the anterior cranial fossa will be highlighted.  \nLearning Objectives:\n1. To learn the imaging techniques and anatomy of the anterior skull base with \nan emphasis on the olfactory apparatus. \n2. To become familiar with the imaging findings. \n3. To learn how to differentiate between lesions in the anterior skull base. \nA-322 16:30 \nB. Middle cranial fossa pathologies  \nA. Borges; Lisbon/PT (borgalexandra@gmail.com) \nThe central skull base, the floor of the middle cranial fossa, has a complex \nanatomy and is pierced by a variet y of foramina and canals providing \ncrossroads for spread of disease between the extra-cranial head and neck and \nthe intracranial compartment. Disease spread into the intracranial compartment \nindicates a dismal prognosis, as often it becomes inoperable due to \ninvolvement of vital structures including cranial nerves, carotid artery and/or \nbrain parenchyma. Imaging plays a pivotal role in the assessment of these \nstructures which are not amenable to clinical inspection and can dramatically \nchange the patient's management. In this complex anatomical area, CT and \nMR have a complementary role in providing a comprehensive roadmap for \ntreatment planning. Of major importance is the pterygopalatine fossa, the \ncavernous sinuses and orbital apex. The former, lying between the pterygoid \nplates and the maxillary sinus, is a major crossroad between the intra- and \nextracranial compartments and should be carefully inspected. Pathologies \naffecting the central skull base are varied and may originate from the skull \nbase proper, from the middle cranial fossa or from the extracranial head and \nneck. By looking at the centre of the lesion, its tissue characteristics and \npattern of growth, it is often possible to  provide a useful differential diagnosis \nand, most importantly, to map the lesion's extent. Here, we present a \nradiologist-friendly approach to central skull base pathology highlighting the \nmost important features in the differential diagnosis and treatment planning.  \nLearning Objectives:\n1. To become familiar with imaging strategies and anatomy of the middle \ncranial fossa. \n2. To learn about imaging findings of common lesions. \n3. To learn how to differentiate between the lesions in middle cranial fossa. \nA-323 17:00 \nC. Posterior cranial fossa pathologies  \nH. Tanghe; Rotterdam/NL (tanghe@planet.nl) \n1. The jugular foramen: The jugular foramen is an opening in the skull base. \nThe radiologic evaluation requires high-quality imaging with CT and MR. \nAngiography is reserved for preoperative embolisation. It is important to \nrecognise the \"pseudo lesions\". The most common tumour of the jugular \nforamen is the paraganglioma. The second is the schwannoma of the lower \ncranial nerve, and the jugular foramen meningioma is the third most common. \nThe differential diagnosis shall be discussed. 2. The cerebellopontine angle \n(CPA) and the internal auditory canal (IAC): The IAC is a bony conduit for \nseveral nerves and a vessel, the neurovascular bundle. The CPA is a cistern of \nthe peripheral cerebral spinal flui d, and several anatomical structures pass \nthrough this. It is also the place of some frequent disease processes. Most of \nthe lesions in the CPA are benign tumours with order of frequency: vestibular \nschwannoma and meningioma. The third most common lesion is a benign \ncystic lesion: the epidermoid cyst. In the IAC, you can encounter the same \nbenign tumoural lesion as in the CPA, but also inflammatory lesions, viral \nlesions and malignant lesions. Why is it important in your imaging protocol of \nthe IAC and CPA region to use gadoliniu m? The differential diagnosis of \ndifferent lesions shall be discussed.  \nLearning Objectives:\n1. To learn about the imaging techniques and anatomy in the posterior cranial \nfossa. \n2. To become familiar with the imaging findings of common posterior cranial \nfossa pathologies. \n3. To learn how to differentiate between the lesions in the posterior cranial \nfossa. \n\nA B C D E F G S73  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n16:00 - 17:30 Board Room A  \nRadiographers  \nRC 1114  \nEvidence-based practice in medical \nimaging: a tool to improve the quality of \ncare\nModerators:  \nC.J. Herold; Vienna/AT \nD. Katsifarakis; Athens/GR \nA-324 16:00 \nA. The radiographer as the interface between patient and technology: \nclinical judgement and professional accountability  \nG. Paulo; Coimbra/PT (graciano@estescoimbra.pt) \nHealth care is characterised by several specific features making it different \nfrom traditional markets. Two of the key features are: the impossibility of \npatients to make choices, due to asymmetry of knowledge between them and \ntheir health-care providers; the fact that patients create an agency relationship \nwith health-care providers, delegating to them the decision about the care \ndelivered. Due to these characteristics and to the fact that patients are fragile \nwhen they need care, there is a natural tendency for patients to rely on health-\ncare professionals. It is in this comp lex socio-technical environment that \nradiographers must be aware of their roles and responsibilities and ensure \nprofessional autonomy and accountability; demonstrate an ethical and \nknowledgeable understanding of the prof ession; apply professional practice in \nsecuring, maintaining or improving health and well-being; develop knowledge, \nskills and competences that underpin their education and training, contributing \nto the wellbeing of the patient; understand that professional advancement \narises out of evidence-based practice and is acquired through focused \nresearch. This demands for a focus on patient care and safety, based on high \nprofessional standards. EBP is the best way to achieve this desideratum, as it \ncombines the best research evidence with clinical knowledge and expertise, \naddressing the patient in a holistic way. Since the radiographer is the ultimate \ninterface between patient and technology, it is crucial to create a real teamwork \nconcept, using guidelines for the roles and responsibilities of each team \nmember as the pathway to minimise practice error, maximising patient and \nstaff safety.  \nLearning Objectives:\n1. To understand the importance of the radiographer in the application of \nevidence-based practices. \n2. To appreciate the need for systematic evaluation of health care technology. \n3. To learn about the importance of critical assessment of research data and \nclinical guidelines. \nA-325 16:30 \nB. Justification and optimisation in medical imaging  \nJ. Santos; Coimbra/PT (joanasantos@estescoimbra.pt) \nThe use of ionising radiation in medical exposures is well documented across \ncountries. Recent studies indicate that a substantial fraction (20 to 50%) of \nthese procedures is unnecessary when taking into consideration patient clinical \nindication. Defensive medicine, eco nomic interest, poor patient clinical \ninformation, patient pressure and the lack of knowledge about other alternative \nprocedures, taking into account the benefits and risks, are the principal causes \nof unnecessary radiological examinat ions. Patients must be referred to a \nmedical imaging department for an examination that should be justified \naccording to clinically appropriate image criteria and informed of the potential \nbenefits and risks. Following justific ation, the optimisation of practice is \nessential to ensure the minimal exposure of radiation dose to the patient whilst \ndiagnostic efficacy is maintained. The pri ncipal aim of optimisation is getting a \nnarrower dose distribution, with lower mean and 75\nth percentile values of the \ndiagnostic reference level. Optimisati on processes need to consider several \nfactors including the type of examinations, body region, clinical information, \navailable equipment technology and image processing tools. To implement this \nprocess, a multidisciplinary teamwork is essential where radiographers, being \nthe pivot between patient and technology, have an essential role. To \nunderstand and apply optimisation procedures, radiographers should be aware \nof the international guidelines, standards and directives. All medical imaging \nprocedures must be audited to analyse if the workflow processes (referral, \njustification, optimisation an d radiation protection principles) are according to \nthe recommendations to create a radiation protection safety culture.  \nLearning Objectives:\n1. To learn about developing and consolidating approaches to justification in \nmedical imaging. \n2. To learn about current optimisation in medical imaging. \n3. To become familiar with international recommendations, standards and \ndirectives. \nA-326 17:00 \nC. Service development through evidence-based approaches  \nE. Metsala; Helsinki/FI (eija.metsala@metropolia.fi) \nAlthough we are approaching the year 2014, a lot of clinical radiography is not \nbased on best evidence. Lot of clinical  decision-making is based on, for \nexample, traditional practices that we cannot argue as being the best possible \nones. In this presentation, barriers to using research and other sources of \nevidence and facilitators of evidence-based (EB) radiography are described. \nThe role radiographers have in developing EB guidelines and procedures may \nvary according to educational level and work description. Developing EB \nguidelines is not the work of every radiographer, but obeying them is. The \nspeaker gives some suggestions on what to do in a situation if there are no EB \nguidelines and procedures in ones' country or institution and no group that \ndevelops them. With the framework of \"the new work order\" and increasing \nimplementation of new work processes, professionals are faced with new \nmodes of collaboration requiring co mmunicative skills as well as multi-\nprofessional competencies between all the stakeholders across the hospital. \nSome evidence about the consequences of ineffective communication in the \nfield of radiography is presented. In addition to benefits associated with the \nprocedure of clinical audit, uniform good quality protocols for examinations and \nuniform national/international criteria help to perform comparisons between \nradiology units. Clinical audit also wo rks as an educational tool and as a \nfeedback tool for the staff on their performance. It also points out the need for \ncorrective actions.  \nLearning Objectives:\n1. To appreciate the challenges in implementing evidence-based approaches \nin the radiology department. \n2. To appreciate the radiographers' role in developing clinical guidelines and \nprocedures. \n3. To understand the importance of enabling effective communication between \nstakeholders across the hospital. \n4. To learn about the importance of audit practices as part of evidence-based \nservice development. \n16:00 - 17:30 Room P  \nEDiR Session  \nEuropean Diploma in Radiology: and the \nbeat goes on!  \nA-327 16:00 \nChairman's introduction: setting the scene for the European Diploma  \nY. Menu; Paris/FR (yves.menu@sat.aphp.fr) \nInitiatives from professional organisations are probably the most powerful \nengines for the construction of Europe, and in many cases open the road for \nlegal and political advances. Many medical  specialties felt that there was a \nneed for the harmonisation and standardisation of medical training over \nEurope. The ESR has shared this opinion and has elaborated a unanimously \nappreciated training curriculum, which is constantly updated. Establishing the \nEBR (European Board of Radiology), with the mission to organise a European \ndiploma was the logical next step. Today, 10 examinations have already been \norganised and more that 350 candidates from European countries and abroad \nhave applied. The trainee who passes the examination proves his professional \nskills and has reached the objectives assigned in the curriculum. In this \nsession, we will explain how ESR organises the diploma. We will review, \ncapitalising on our current experience, the main lessons learnt from the past \neditions, the keys for success and reasons for failure, as seen by the \nexaminers. We will also learn about the \"Diploma adventure\", from the point of \nview of a successful candidate.  \nSession Objectives:\n1. To learn more about the organisation of the European Diploma (EDiR). \n2. To appreciate the benefits of taking the examination. \n3. To be informed about the experience acquired by the examiners and the \ncandidates. \n4. To understand the development of the EDiR in Europe and abroad. \n\nA B C D E F G S74  \nSaturday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-328 16:05 \nWho really needs a European Diploma in Radiology?  \nW. Schima; Vienna/AT (wolfgang.schima@khgh.at) \nNational radiology training programmes in Europe differ to a large extent, \nregarding length of training, content, and the presence or absence of a national \nboard examination for certification. Thus, for cross-border radi ologic activities, \nthe level of training and expertise applying to radiologists is difficult to assess \nunder these circumstances. There is an increasing number of medical \nsubspecialties, which organise European diplomas. More than 20 \nsubspecialties (e.g. anaesthesiology, ophthalmology, urology, etc). organise \nEuropean examinations, which are well received among the respective \ncommunities. Growing numbers of residents in training successfully stand this \ntest of knowledge and practical skills. Recognition of European diplomas by \nnational authorities is an issue, which will increase the level of acceptance. The \npresent status of the recognition process in European countries will be \nsummarised.  \nLearning Objectives:\n1. To learn why the European Diploma in Radiology is useful in the era of \ncross-border radiology and teleradiology. \n2. To understand how EDiR contributes to the harmonisation of the training \nprogrammes across Europe and, at the same time, sets a standard of quality. \n3. To appreciate the experience from other specialties, demonstrating that \nEuropean diplomas are a general trend in medical specialties. \nA-329 16:25 \nLearn from past mistakes: lessons to improve your preparation and \nperformance  \nS. Barter1, L. McKnight2; 1Cambridge/UK, 2Langland/UK\n(suebarter@btinternet.com) \nCase material for the diploma will test knowledge in general radiology at a \nstandard to be expected at the end of training as outlined in the ESR \ncurriculum. All ten ESR-recognised subspecialty areas of the curriculum will be \ntested. The written exam comprises two computer-based sections, a multiple \nresponse section, and a short case section. There will be 75 multiple response \nquestions. These questions comprise both multiple options format, a single \nstem with 5 answer options, and short imaging studies where candidates are \nasked to either annotate the image from a drop-down menu, or select the \nradiological features displayed or differ ential diagnosis from the options given. \nA special scoring system has been developed to prevent guessing. The short \ncase section comprises 4 or 5 case-based questions. You may practice using \nthe self-assessment tests on the ESR website which follow the same format as \nthe written examination. For the oral cases, you must have a systematic \nmethod and perform under pressure, which takes practice. You may rehearse \nwith experienced radiologists who feedback on your performance. You can \nbreak a radiology report into 3 areas, observations, interpretation and \nconclusion. Conclusions should take into account the clinical information. \nCandidates often forget this under pressure, so ask for it to be repeated. Your \ndifferential diagnosis should be logical and comprehensive. The 3 commonest \ncauses of an abnormality is a good topic to revise. Suggest if further imaging \ntests are indicated and give an indication of urgency. Each case is marked \nseparately.  \nLearning Objectives:\n1. To learn how questions are formulated and selected for the written and oral \nexaminations. \n2. To become aware of some examples of the most common errors made by \nthe candidates. \n3. To learn the best approach to the oral examination and what examiners \nreally expect from the candidates. \n4. To learn some tricks that may help candidates prepare for EDiR. \nAuthor Disclosure:\n S. Barter: Board Member; Scientific Board EBR. \nA-330 16:55 \nWe made it! The Turkish Board of Radiology values EDiR  \nS.S. Özbek; Izmir/TR (sureyya.ozbek@ege.edu.tr) \nAs a well-known statement in the academic world of education, \"assessment \ndrives learning\". With the help of carefully prepared and performed \nexaminations, it is possible to emphasise and instill the training curriculum. \nDue to different reasons, training of radiology in European countries is highly \nvaried. Like in our experience in Turkey, a central examination system, \naccompanied by a neatly prepared training charter and curriculum, is a good \nstarting point to solve the problem. We believe that a common European \nassessment system like EDiR will contribute a great deal to the harmonisation \nof radiological training and establishment of quality standard in every country. \nThe need for harmonising the training is not unique to radiology. This is why in \nmore than 30 medical disciplines, European diploma examinations are now \nbeing organised. Furthermore, in some disciplines like urology, annual and \nonline \"In-Service Assessment\" of residents and practising urologists allows \nthe participants to evaluate their current knowledge base against the current \nEuropean standards, and also provides the trainers and directors knowledge \nabout the teaching and learning process in education centres. Although there \nare huge diversities among different European centres, the urgent need of \nharmonising radiology training and setting a standard of quality are felt by all \nradiologists in Europe. Establishing and institutionalising a common \nassessment system in European radiology appears to be the shortest way to \nreach this goal. This is why we should support \"European Diploma in \nRadiology\" by any means and work hard to promote its recognition throughout \nthe continent.  \nLearning Objectives:\n1. To learn the reasons why the Turkish Board of Radiology has decided to \nrecognise the EDiR as equivalent to the first part of their national examination. \n2. To understand how EDiR contributes to the harmonisation of training \nprogrammes across Europe and, at the same time, sets a standard of quality. \n3. To appreciate the experience from other specialties, demonstrating that \nEuropean diplomas are a general trend in medical specialties. \nA-331 17:15 \nI did it! Lessons from a successful candidate  \nJ. Muscat, A. Mizzi; Birkirkara/MT (jessica2860@gmail.com) \nThe purpose of this lecture is to outlin e a candidate's incentive for taking the \nexam, share my EDiR experience and discuss the EDiR's 'returns' from a \ncandidate's point of view. Hailing from the small island state of Malta, local \npostgraduate training is a concept almost as new as the EDiR itself. The \nOctober 2012 sitting of the EDiR happened to fill in the gap just prior to the UK \nFinal FRCR Part 2B I was preparing to take in the spring. Preparation for the \nEDiR went, quite simply, in tandem with that for the FRCR consisting of \nrevision cases - online and in textbooks - of imaging-by-system and the vitally \nimportant \"hot\" seat sessions - mimicking the oral exam - with consultant \nradiologists. Another factor that influenced my taking the EDiR was undeniably \nthe venue - the Journées Françaises de Radiologie in Paris. Though \npostgraduate training in radiology may vary, as aptly put by Prof Maximillian F. \nReiser, the aim of the EDiR is \"the enhancement and harmonisation of \nradiological training in Europe\": the EDiR can now be considered a potential \nEuropean certification in radiology and as such an opportunity not to be \nmissed!  \nLearning Objectives:\n1. To understand the general atmosphere of an EDiR exam from the \nperspective of a candidate. \n2. To understand the candidate's motivation for applying for the examination. \n3. To appreciate what the real and potenti al benefits of taking the examination \nare. \n\nA B C D E F G S75  \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n\u0012\"\u001d\u0016\u0014#\u0002\u0001\u0010\u0014\u001f\u0015\u0019\u0001\r\u0001\n\nA B C D E F G S76  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n08:30 - 10:00 Room A  \nInteractive Teaching Session  \nE³ 1220  \nPitfalls in brain imaging  \nA-332 08:30 \nA. CT  \nL. van den Hauwe, J.W. Van Goethem, C. Venstermans, F. De Belder, \nT. van der Zijden, M. Voormolen, P.M. Parizel; Antwerp/BE\n(lucvdhauwe@mac.com) \nThe majority of emergency CT studies reported by junior radiologists or \ngeneral radiologists out-of-hours compri se brain scans. Brain CT studies are \noften performed to detect acute life-threatening abnormalities, such as stroke, \nintraparenchymal or subarachnoid haemorrhage, cerebral edema, etc. \nMisrecognition of these often subtle, but life-threatening abnormalities can lead \nto inappropriate patient management and worsen patient outcome. Errors in \ninterpretation can generally be categorised as either perceptual or cognitive in \nnature. Perceptual errors are those in which the radiologist does not see the \nabnormality, resulting in a false-negative interpretation (e.g. basilar artery \nthrombosis, deep cerebral venous thrombosis, PRES,…). Cognitive errors, on \nthe other hand, are those in which an abnormality is identified but the meaning \nor significance of the abnormality is not recognised. Cognitive errors can result \nin false-positive interpretation if, for example, a normal anatomic variant is \nmistaken for a pathologic condition. While the ͒more common normal variants \nand artefacts often do ͒ not present a problem to experienced clinicians and \nneuroradiologists, less experienced individuals should beware of these \ndiagnostic hazards. To reduce false-neg ative and false-positive reporting, a \nchecklist of the review areas (blind spots) to be verified on any brain CT scan \nwill be offered and the most frequent normal variants will be discussed.  \nLearning Objectives:\n1. To learn about common pitfalls in CT evaluation of the brain. \n2. To become familiar with anatomical variants potentially mimicking disease. \nA-333 09:15 \nB. MRI  \nD. Prayer; Vienna/AT (daniela.prayer@meduniwien.ac.at) \nPitfalls in brain imaging comprise perceptual or cognitive errors of \ninterpretation of imaging findings. Errors of perception refer to a missing of a \npathology that is present on an image, while cognitive errors consist of a wrong \ninterpretation of a seen structure or pathology. Interpretation may be false \nnegative or false positive. In addi tion, a wrong conclusion may be drawn \nresulting from missing, incomplete or false clinical information, or as a \nconsequence of a lack of knowledge of differential diagnoses. Perception \nerrors are frequently the consequence of incomplete examination protocols \nwhere lesions are missed (for instance, acute ischaemic changes without the \nuse of diffusion-weighted Imaging) or signals, for instance, flow-related \nphenomena are misinterpreted. Asymmetri c positioning of the patient`s head \nmay also lead to misinterpretation of si de differences, especially in the \ntemporal lobe. Another source of perception errors might be reduced attention \n(especially at night shifts) and have been proved to occur in regions that are \n\"potential blind spots\", as the sulci, cavernous sinus, Meckel cave, dural \nsinuses, brainstem, and skull base foramina. Perceptual errors may be avoided \nby following a checklist when reading images. All sequences should be used \nfor comparison of signal intensities to distinguish artefacts from pathology. \nAnother very important fact to avoid misinterpretation lies in a profound \nknowledge of morphologic and metabolic age-related changes of the brain and \nof anatomical normal variants (such as, for instance, accentuated Virchow \nRobin spaces in certain locations).  \nLearning Objectives:\n1. To learn about common pitfalls in MRI evaluation of the brain. \n2. To become familiar with anatomical variants potentially mimicking disease. \n08:30 - 10:00 Room B  \nAbdominal Viscera  \nRC 1201  \nThe many faces of benign liver lesions  \nModerator:  \nA. Ba-Ssalamah; Vienna/AT \nA-334 08:30 \nA. Vascular  \nM. Karcaaltincaba; Ankara/TR (musturayk@yahoo.com) \nBenign hypervascular focal liver lesions include haemangioma, focal nodular \nhyperplasia, hepatic adenoma, angiomyolipoma, nodular regenerative \nhyperplasia and haemangioendothelioma. Tips for differentiation of benign and \nmalignant hypervascular liver lesions will be presented. US, CT and MRI \nfindings will be summarised with emphasis on typical and atypical findings. \nLiver imaging is important for noninvasive diagnosis of hypervascular benign \nliver lesions and confidence in diagnosis can obviate biopsy in routine clinical \npractice.  \nLearning Objectives:\n1. To become familiar with typical and infrequent manifestations of benign \nhypervascular focal liver lesions. \n2. To learn how to differentiate between benign and malignant lesions. \n3. To appreciate the limitations and complementary roles of CT and MR. \nA-335 09:00 \nB. Cystic  \nG. Brancatelli; Palermo/IT (gbranca@yahoo.com) \nCystic liver lesions can be classified based on their nature as benign and \nmalignant. In the benign category are, among others, developmental and \ninfectious/inflammatory cysts, while neoplastic cyst can be subdivided into \nprimary and secondary. Developmental cysts originate from abnormal ductal \nplate malformation and consist of hepatic (bile duct) cyst, bile duct \nhamartomas, Caroli's disease and polycystic liver disease. \nInfectious/inflammatory cysts include, among others, abscesses (pyogenic and \namoebic) and hydatid cysts. Primitive neoplastic cystic lesions are \ncystoadenoma and cystoadenocarcinoma. Secondary lesions can originate \nmostly from mucinous tumours such as colon and ovary. The role of cross-\nsectional imaging in the detection and characterisation of these entities will be \ndiscussed, with an emphasis on the di fferential diagnosis with CT and MR \nImaging.  \nLearning Objectives:\n1. To understand the features of congenital and infectious cystic liver lesions. \n2. To learn how to differentiate between benign and malignant cystic lesions. \nAuthor Disclosure:\n G. Brancatelli: Speaker; Bayer. \nA-336 09:30 \nC. Hepatocellular  \nF. Caseiro-Alves; Coimbra/PT (caseiroalves@gmail.com) \nBenign hepatocellular neoplasms are being recognised with increased \nfrequency using cross-sectional imaging. One of the main goals is to be able to \nmake a clear-cut differential diagnosis between focal nodular hyperplasia \n(FNH) and hepatocellular adenoma (HCA) since patient management is \nsubstantially different. Despite the sound knowledge acquired in the last few \nyears about the morphological features of FNH using various cross-sectional \nimaging techniques, new players in the field have arisen such as diffusion-\nweighted MR imaging (DWI) and use of hepatobiliary contrast agents. These \nnew biomarkers offer a different view over FNH and allow a more accurate \ncharacterisation even in more atypical cases. Concerning HCA, current \nknowledge implies that the sub-types of this neoplasm should be known since, \nagain, patient management differs and these patients are no longer seen as \ncompulsory surgical candidates. These sub-types will be further discussed and \nthe role of imaging for risk stratification (haemorrhage and malignant \ntransformation) will be addressed. Further, illustrative cases of combined \nFNH/HCA cases will be demonstrated along with the main imaging clues for a \nsuccessful differential diagnosis.  \n\nA B C D E F G S77  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To understand the typical aspect of hepatocellular benign lesions on US, CT \nand MRI. \n2. To learn when a liver specific contrast medium can help us in the proper \ncharacterisation of hepatocellular benign liver lesions. \n3. To understand the classification of liver adenomas, prognosis and imaging \ncharacteristics. \nAuthor Disclosure:\n F. Caseiro-Alves: Advisory Board; Euromedic. Consultant; Bayer Schering. \n08:30 - 10:00 Room C  \nModern Imaging of the GI Tract  \nCC 1221  \nImaging the postoperative patient  \nModerator:  \nM. Hellström; Gothenburg/SE \nA-337 08:30 \nA. What the surgeon does: surgical procedures and normal postoperative \nanatomy  \nM.M. Maher; Cork/IE (m.maher@ucc.ie) \nIn most upper and lower gastrointestinal surgical units, imaging is frequently \nrequired in patients suspected of post-operative complications or in whom \nrecovery would appear delayed. Interpretation of these studies can be \nchallenging and requires an appreciation of expected imaging appearances of \nthe post-operative abdomen as well as the anatomy of common surgical \nprocedures. Imaging findings in the post-operative abdomen can vary \nsignificantly, depending on the surgi cal procedure performed and this can \nresult in pitfalls for the radiologist.  \nLearning Objectives:\n1. To understand common surgical procedures performed in the esophagus, \nstomach, small bowel and colon. \n2. To appreciate the normal appearance of an enteric anastamosis on \nfluoroscopic and cross-sectional imaging. \n3. To understand the normal appearances of haemostatic packing and other \nsurgical devices on radiological investigations. \nA-338 08:50 \nB. Do I need to re-operate? Postoperative imaging and immediate \ncomplications  \nD.J.M. Tolan; Leeds/UK (djmtolan@doctors.org.uk) \nImaging in the early postoperative period is complex. It is essential for \nradiologists to know the new anatomic arrangement after surgery and to \nunderstand the range of normal postoperative appearances. This latter aspect \ncan be particularly difficult, because the radiological findings are affected by \nthe type of operation performed (open vs. laparoscopic) and the complexity of \nthe surgery (such as the presence of adhesions or haemorrhage) as well as \nthe underlying comorbidity of the patient. Patients may be considered in 4 \nbroad categories: haemodynamically unstable patients who may be bleeding; \npatients with distension or unopened bowels who may have obstruction or \nileus; patients with sepsis in whom to s earch for an intraabdominal collection or \nleak; and patients who do not follow an expected recovery for which the cause \nis unclear. CT is the primary imaging technique, with ultrasound reserved \npredominantly for liver and renal transplants or assessment of perihepatic \ncollections, and fluoroscopy for routine postoperative assessment of upper and \nlower GI anastomoses. CT protocols should be optimised to detect particular \ncomplications with positive luminal contrast for assessment of anastomotic \nleaks (8%), triple phase imaging for bleeding (without positive oral contrast) \nand delayed phase imaging to detect ureteric injury. Since each operation has \na specific range of expected complications, these should be considered when \ndeciding on the protocol and in light of the patient's clinical status. Excellent \ncommunication with the surgical team is required to make an accurate \ndiagnosis and in particular where haemostatic compound or mesh for hernia \nrepair was used.  \nLearning Objectives:\n1. To understand the best imaging options for investigating suspected \npostoperative complications. \n2. To appreciate the normal appearances of the abdomen and pelvis after \nsurgery, in particular with regard to free fluid, haematoma and free gas, and \nwhen to suspect complications. \n3. To become familiar with the radiological appearances of common and more \nunusual post-operative complications and their interventional radiological \nmanagement. \nAuthor Disclosure:\n D.J.M. Tolan: Equipment Support Recipient; Vital Imaging. Speaker; Bracco. \nA-339 09:10 \nC. It still hurts: follow-up imaging and long-term complications  \nL. Curvo-Semedo; Coimbra/PT (curvosemedo@gmail.com) \nRadiologists should be aware of the new er surgical techniques and expected \npost-operative alterations, to yield a correct interpretation of a post-surgery \nimaging examination, thus being able to differentiate a normal post-operative \nfinding from a potential complication. In this setting, it is crucial to perform a \ntechnically adequate imaging examinati on, so that post-operative anatomical \nand functional findings may be evaluated. Therefore, the aim of this lecture is \nto give an overview of the contribution of various imaging modalities in the \ndiagnosis of late post-operative complicatio ns following GI tract surgery. It will \ninclude a mention of the technical i ssues that need to be considered to achieve \nbetter diagnostic accuracy, as well as a description and illustration of the main \nimaging findings of late post-operative complications. Those include disease-\nrelated (recurrence for malignancy or inflammatory disease) and procedure-\nrelated (anastomotic strictures, internal herniation, adhesions and \nintussusception, among others) complications. Focus will be placed on cross-\nsectional imaging techniques, which at present constitute the workhorse for \ndetecting and characterising late post-operative complications after GI tract \nsurgery. In this way, imaging has an  obvious and pivotal role in planning \ntherapy, since some late complications are usually treated in a conservative \nway while others require a surgical approach.  \nLearning Objectives:\n1. To become familiar with the long-term complications of surgery to the GI \ntract. \n2. To appreciate the appropriate use of imaging in the assessment of long-term \ncomplications. \n3. To learn about the radiological investigation of suspected postoperative \nadhesions. \nA-340 09:30 \nD. Interactive case discussion  \nM. Hellström; Gothenburg/SE \n08:30 - 10:00 Room D  \nChest  \nRC 1204  \nLung cancer: staging and personalised \nimaging in 2014  \nModerator:  \nE.J.R. van Beek; Edinburgh/UK \nA-341 08:30 \nA. Lung biopsy: who, how and why  \nF. Laurent; Pessac/FR (francois.laurent@chu-bordeaux.fr) \nLung biopsy of a suspected lung cancer remains a well-established technique \nfor histopathologic examination in patients with suspected lung cancer. \nComplications can nevertheless occur and t herefore indication should be given \nafter carefully balancing the benefits and drawbacks for a particular patient. \nThe method should be clearly considered complementary to alternate methods \nof tissue sampling, fiberoptic endos copic, mediastinoscopy or US-guided \nendoscopy, surgical biopsies and rese ction during a multidisciplinary \ndiscussion. Several steps are needed in the preparation of the biopsy \nprocedure, including informed consent, management of anticoagulation and \nanti-platelet medications, imaging assessment of the lesion and its \nenvironmental lung, and planing of the needle trajectory procedure. The choice \nof the guiding method and the most appropriate biopsy needle is still largely \ndependent on local skills and habits. CT-guided percutaneous biopsies using \ncoaxial automated core biopsy needles offer many advantages. Needle \nmanipulation can help to reach difficult targets. Participation of the patient is \nneeded in terms of respiratory manoeuvres and breathhold. Complications may \noccur such as pneumothoraces haemorrhage and air embolism. Knowledge of \nthe respective risk factors and the potential method of prevention or treatment \nby operators are essential.  \nLearning Objectives:\n1. To learn when biopsy is necessary in patients with lung cancer. \n2. To understand the importance of molecular diagnostic testing in lung cancer. \n3. To appreciate the different techniques available for obtaining a histological \ndiagnosis in patients with lung cancer. \n\nA B C D E F G S78  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-342 09:00 \nB. Pre and post-treatment tumour assessment  \nN. Tacelli; Brussels/BE (ntacelli@gmail.com) \nThe therapeutic response of lung cancer can be objectively evaluated on the \nbasis of changes in the tumoural size or depiction of metastases, such \nproposed in the RECIST criteria (Response Evaluation Criteria In Solid \nTumours). Recent advances in cancer biology have triggered development of \nnovel targeted therapies designed to disrup t specific biologic pathways. Among \nthem, antiangiogenic drugs represent a promising strategy for non-small cell \nlung carcinomas (NSCLC). These agents are more cytostatic rather than \ncytotoxic, explaining the limitations of tumour response assessment based on \nmorphological criteria. Dynamic contrast-enhanced imaging techniques have \nthe potential to quantify tumoural angiogenesis. In particular, dynamic contrast-\nenhanced multidetector-row CT (DCE-CT) represents a promising tool to \nprovide non-invasive and repeatable assessment of the angiogenic process \nwithin non-small cell lung cancers (NSCLC), offering the possibility to generate \nmorphological and functional information from the same examination. DCE-CT \nallows the calculation of regional tumour blood flow, blood volume, flow-\nextraction product, and permeability-surface area product, over the entire \ntumoural volume, using mathematical models and dedicated softwares. DCE-\nCT can depict early changes in lung cancer vascularity, before tumour \nshrinkage, that could help predict resp onse to antiangiogenic drugs. Becoming \nfamiliar with this technique enables the radiologist to integrate it into clinical \npractice and to assist the thoracic onc ologist in the pre-therapeutic and \nfollow-up evaluation of NSCLC patients treated by antiangiogenic drugs. This \nnew approach should improve patient's selection for targeted therapies.  \nLearning Objectives:\n1. To learn about the practical approach for assessing disease response in \npatients with lung cancer. \n2. To become familiar with new therapies in lung cancer. \n3. To appreciate new techniques such as perfusion CT in assessing disease \nprognosis and response in lung cancer. \nA-343 09:30 \nC. The role of PET-CT and whole body MRI  \nF. Gleeson; Oxford/UK (fgleeson@mac.com) \nIt is now accepted that PET-CT is of value in the staging of lung cancer and \nreduces the number of unnecessary thoracotomies. Its role has been further \nclarified by recent publications on its val ue in assessing mediastinal nodal \ninvolvement, tumour aggressiveness using either standardised uptake value or \ntotal glycolytic volume, and response to neoadjuvant chemotherapy. More \nrecently, MRI has been investigated as a tool to detect distant disease using \ndiffusion-weighted imaging, and there are a number of trials that have \ncompared both PET-CT and DWI MRI retrospectively and prospectively. This \npresentation will summarise the current available data and the likely benefits of \neither imaging modality  \nLearning Objectives:\n1. To learn about the role of PET-CT in staging and determining prognosis in \nlung cancer. \n2. To appreciate the role of PET-CT in determining disease response in lung \ncancer. \n3. To become familiar with the potential use of whole body MRI and DWI in \nlung cancer. \n08:30 - 10:00 Board Room B  \nPaediatric  \nRC 1212  \nPaediatric emergencies  \nModerator:  \nJ.-P. Van Nieuwenhuyse; Luxembourg/LU \nA-344 08:30 \nA. The acute non-traumatic neurological patient: CT or MRI?  \nE. Vázquez; Barcelona/ES (evazquez@vhebron.net) \nNeurological deficits in children are an urgent condition that depends \nsignificantly on imaging for a prompt and accurate diagnosis because of the \nsignificant overlap present in clinical  history, presentation and neurological \nexamination. Different imaging modalities, such as ultrasound, computed \ntomography (CT) or magnetic resonance imaging (MRI), are utilised dependent \non the age of the patient and neurological symptoms. The purpose of the \npresent lecture is to discuss the causes and imaging appearance of acute \nneurological conditions in childhood, broadly classified into stroke, infection, \ninflammatory demyelination, metabolic disorder, cerebral neoplasm or \nneurotoxicity. Imaging also plays an outstanding role in the management of \npaediatric oncology patients present ing with acute neurological symptoms \nrelated to disorders of blood cell counts, immunosuppression, neurotoxicity of \ntherapy, or progression of the primary malignancy. A review of the main \nindications to perform a neuroimaging procedure in these children will be \nundertaken as well as a differential diagnosis based on representative cases \nselected from the daily routine in a paediatric tertiary hospital. Practical \nalgorithms with the preferential use of either CT or MRI will be developed for \neach section. CT continues to be the first imaging modality in these patients in \nmany centres, despite the accompanying radiation, because of the easy \navailability and no requirement of sedation. However, MR imaging is nowadays \nbetter for imaging these children owing to no radiation, the more completely \nprovided information and the useful advanced techniques that can be used, \nsuch as diffusion imaging (DI), spectroscopy, arterial spin labelling (ASL), and \nsusceptibility weighted imaging (SWI).  \nLearning Objectives:\n1. To learn about the currently limited role of CT in the non-traumatic acute \nsetting. \n2. To become familiar with radioprotection strategies and protocols adapted to \nchildren. \n3. To consolidate knowledge on the role of MRI as the modality of choice for \nacute non-traumatic neurologically ill children, with an emphasis on newer \ntechniques. \n4. To become familiar with imaging findings and the main differential diagnosis \nof acute neurological conditions in children. \nA-345 09:00 \nB. Imaging of acute chest pain and distress in children  \nC.E. de Lange; Oslo/NO (clange@ous-hf.no) \nAcute chest pain in children is a common complaint in the emergency \ndepartment, but patients rarely present with significant distress or life-\nthreatening symptoms requiring immediate care or resuscitation. The most \nfrequently reported cause is benign musculoskeletal pain followed by \nrespiratory and gastrointestinal causes, while cardiac causes are less frequent. \nA thorough clinical history and careful physical examination will determine, in \nmost cases, the patients in need of further investigation to establish a \ndiagnosis. In this regard, radiology play s an important role, especially in the \nemergency setting in patients with more serious associated symptoms like \nacute breathing difficulties, swallowi ng problems, fever or sepsis. When \nchoosing the appropriate technique for investigation, the consequences of \nradiation exposure in children must be considered. Plain radiography and \nfluoroscopy still remain the most important and frequently used tools to gain \ninformation on various acute chest/pulmonary problems. Ultrasonography is \nthe first choice for diagnosis/treatm ent of pleural effusions. Multidetector \ncomputed tomography and magnetic resonance imaging are mainly used for \ninvestigating pulmonary/mediastinal masses and congenital abnormalities of \nthe great vessels and the lungs. This lecture will discuss the choice of imaging \ntechnique and the urgency of radiological management depending on the \nsymptoms and age of the patient. The imaging characteristics of the different \ncauses of acute chest pain and/or distress in children will be reviewed, \nrepresented by the more common conditions involving the chest wall, \nrespiratory tract, oesophagus and the heart, as well as less frequent causes \nsuch as tumours, manifestations of congenital malformations and non-\naccidental trauma.  \nLearning Objectives:\n1. To understand the role of radiographs, US, CT and MRI. \n2. To become familiar with the most common conditions that cause acute chest \npain and distress in children. \n3. To appreciate the different differential diagnoses, depending on the age of \nthe patient. \n4. To understand the consequences of delaying their diagnosis and treatment. \nA-346 09:30 \nC. The role of the interventional radiologist in paediatric trauma  \nJ.B. Karani; London/UK (john.karani@nhs.uk) \nOutcome data from trauma series have demonstrated improved patient \nsurvival by the prompt diagnosis of a range of injuries and the recognition of \nlife-threatening sequels, principally that of active arterial haemorrhage. Widely \nused trauma scoring systems are applicable in the paediatric population, \nalthough the mechanisms and combination of injuries may differ from those \nencountered in adults. A CT diagnosis of active haemorrhage demands early \noperative or non-operative intervention with embolisation or use of alternative \nendovascular techniques including deployment of vascular stents. This \nprinciple is applicable to blunt or  penetrating liver, splenic, renal or pelvic \ntrauma. It is also applicable in some cases to severe mediastinal and limb \nvascular injury. Important caveats are firstly the use of CT in an overall trauma \nservice and avoidance of any inappropriate irradiation. Secondly, in paediatric \ninterventional practice, due regard needs to be given to the delivery of \nimplantable devices that may have adverse sequels in later life. Nevertheless, \nthe demand for immediacy in intervention may outweigh any such \n\nA B C D E F G S79  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nconsideration. This presentation will summarise the importance of imaging and \nintervention in both the early and delayed complications of trauma with an \nemphasis on abdominal and thoracic trauma.  \nLearning Objectives:\n1. To understand the role of CT, CTA and conventional angiography in the \ndiagnosis of traumatic vascular complications. \n2. To understand the importance of vascular and non-vascular intervention \nfollowing trauma in children. \n08:30 - 10:00 Room E1  \nMusculoskeletal  \nRC 1210  \nPeripheral nerve imaging: MRI and US  \nModerator:  \nM. Maas; Amsterdam/NL \nA-347 08:30 \nA. Anatomy and pathology of the brachial plexus  \nS. Gerevini; Milan/IT (gerevini.simonetta@hsr.it) \nBrachial plexus originates from the ventral branches of the cervical nerve roots \nfrom C5 to T1. It is composed of roots, trunks, divisions, cords, and branches, \ntopographically divided into supraclavi cular (roots and trunks), retroclavicular \n(divisions), and infraclavicular sections (cords and branches). MRI has the \nadvantages of multiplanar imaging, high tissue contrast, and relative paucity of \nartefacts. The T1-weighted sequences display topographic anatomy including \nmuscles, blood vessels, and nerves stressed by tissue fat planes. The nerves \nappear as elongated fibres that are isointense to the scalene muscle, \nposteriorly and superiorly to the curvilinear flow void of the subclavian artery. \nThe fat-suppressed PD and T2-weighted and STIR sequences detect signal \nalterations of the BP. General abnormal findings include: loss of fat planes \naround part or all BP components, nerve signal abnormalities with mild or \nmarked hyperintensity on T2-weighted images that can be associated with \nswelling, focal or extensive enhancement of the nerves after Gad injection on \nT1 fat sat images. Differences in signal intensity should be judged by visual \ninspection, which is susceptible to a subjective point of view; the comparison of \nboth sides of BP has a relevant role in judging the presence of signal \nalterations, especially when they are smooth and/or focal. The pathology of \nbrachial plexus can be divided into nontraumatic and traumatic brachial \nplexopathies. Among nontraumatic brachial plexopathies, we find radiation \nfibrosis, metastatic breast cancer and primary or metastatic lung cancer. Other \npathologies are tumours and inflammatory disease or thoracic outlet disease.  \nLearning Objectives:\n1. To understand the anatomy of the brachial plexus as seen with MRI. \n2. To appreciate the range of pathology seen at the brachial plexus. \n3. To become familiar with the MRI findi ngs of brachial plexus pathology. \nA-348 09:00 \nB. Upper limb nerve entrapment  \nD. Weishaupt; Zurich/CH (dominik.weishaupt@triemli.zuerich.ch) \nThe peripheral nerves of the upper limb are affected by a number of \nentrapment and compression neuropathies. These syndromes involve the \nbrachial plexus as well the musculocutaneous, axillary, subscapular, ulnar, \nradial and median nerves. Clinical examination and electrophysiological \nstudies are traditionally the mainstay of diagnostic workup. However, \nultrasonography and magnetic resonance imaging (MRI) may provide key \ninformation about the exact anatomic location of the lesion or may help to \nnarrow the differential diagnosis. In ce rtain patients with the diagnosis of a \nperipheral neuropathy, imaging using either ultrasonography or MRI may help \nestablish the cause of the condition and provide information crucial for \nconservative management or surgical planning. In addition, imaging is \nparticularly valuable in complex cases with discrepant nerve function test \nresults.  \nLearning Objectives:\n1. To become familiar with the strengths and weaknesses of US and MRI for \nassessing upper limb nerves. \n2. To appreciate the imaging findings of upper limb nerve entrapment. \nA-349 09:30 \nC. Lower limb nerve entrapment  \nC. Martinoli; Genoa/IT (carlo.martinoli@libero.it) \nA variety of peripheral neuropathies can be encountered in the lower limb. \nMost are entrapment syndromes affecting many nerves, such as the sciatic, \ngluteal, femoral, lateral femoral cutaneous, obturator and pudendal around the \nhip, the peroneal and its branches and the saphenous at the knee, the \nsuperficial peroneal at the lateral leg, the tibial with its plantar and calcaneal \nbranches at the ankle, the deep peroneal and the interdigital nerves in the foot. \nAlthough clinical examination and nerve conduction studies are the mainstay of \nthe diagnostic workup of peripheral neuropathies, ultrasound (US) and \nmagnetic resonance (MR) imaging may provide key information about the \nexact anatomic location of a lesion and the nature of the constricting finding or \nmay help narrow the differential diagnosis. In patients with peripheral \nneuropathies of the lower extremity, US and MR imaging may provide critical \ninformation for planning an adequate treatment strategy. Although US and MR \nimaging have followed parallel paths for nerve imaging with little comparison of \nthe two modalities, US seems to have some advantages over MR imaging, \nincluding higher spatial resolution, time effectiveness, the ability to explore long \nnerve segments in a single study and to examine tissues in both static and \ndynamic states.  \nLearning Objectives:\n1. To become familiar with the strengths and weaknesses of US and MRI for \nassessing lower limb nerves. \n2. To appreciate the imaging findings of lower limb nerve entrapment. \n08:30 - 10:00 Room E2  \nNeuro  \nRC 1211  \nStroke: diagnosis, mimics and treatment  \nA-350 08:30 \nChairman's introduction  \nB.F. Schuknecht; Zurich/CH (image-solution@ggaweb.ch) \nAdvances in diagnosis of acute stroke have been achieved by brain imaging. \nCT or MRI distinguish ischaemia from haemorrhage and may identify acute clot \n(dense artery sign) or vessel wall pathology by \"black blood MRI\". DWI \nprovides evidence of early infarction. CT and MRA enable identification of large \nvessel pathology as potential source of embolic or haemodynamic ischaemia. \nSupplementary techniques are CT or MR perfusion. On MRI perfusion, a \nmismatch between the area of restricted diffusion and perfusion (PWI) is a \nsignature of the penumbra. The tissue of PWI restriction outside of the DWI \nabnormality represents \"tissue at risk\". Similarly on CT perfusion, the region of \nreduced cerebral blood volume presumably represents irreversible infarction \nand the area of reduced CBF and extended MTT visible beyond the cerebral \nblood volume abnormality represents potentially reversible ischaemia. \nMorphologic imaging and advanced st andardised perfusion/penumbral stroke \nprotocols aim at identifying lesions t hat are amenable to acute stroke therapy \nand exclude pathologies that mimic stroke but do not represent vascular \ndisease. Since iv tPA has become an approved therapy from 1996, the number \nof acute stroke patients entitled for treatment has remained limited (~ 5) \ndespite extension of the time frame from 3 to 4.5 h. DWI-FLAIR mismatch and \nan individualised assessment of the ischaemic penumbra may serve in the \nidentification of patients within the approp riate time frame. By selection of \npatients with advanced brain imaging and initiation of appropriate therapy, a \nfurther increase in good outcomes and reduction of the incidence of \nsymptomatic haemorrhage may be achieved.  \nA-351 08:35 \nA. Imaging acute stroke: value of CTA and perfusion  \nP.M. Parizel, C. Venstermans, F. De Belder, T. Van der Zijden, \nJ.W. Van Goethem, L. van den Hauwe, M. Voormolen; Antwerp/BE\n(paul.parizel@uantwerpen.be) \nIn recent years, the role of imaging in the patient admitted with an acute \nneurologic deficit has changed signif icantly, due to the arrival of new \ntreatments for acute stroke, aimed at re-establishing blood flow, reducing \ninfarct size and protecting the brain at ri sk. The first goal is to differentiate \nhaemorrhagic from ischaemic stroke and to rule out other stroke mimics. This \ncan be achieved by performing nonenhanced CT scan of the brain. The next \nstrategic imaging objectives include: demonstration of major blood vessel \nocclusion (e.g. by CT angiography) and id entification of potentially salvageable \nbrain tissue, the so-called \"penumbra\" (e.g. by CT perfusion). CT angiography \nis performed during rapid intravenous bolus injection of a high-concentration \niodinated contrast agent. The FOV should cover not only the intracranial \narterial circulation, but also the arteri es of the neck, to exclude dissection. CT \nperfusion is also achieved by bolus injection of contrast, followed by a series of \nfast images or volume acquisition. CT densities change over time and reflect \nthe iodine concentration. Perfusion images are processed to generate \nparametric maps, which reflect: regional cerebral blood flow (rCBF), blood \nvolume (rCBV), mean transit time (MTT), and time to peak (TTP).The \ncombination of CT angiography and CT perfusion provides a unique insight \ninto the pathophysiology of the cerebral circulation. These techniques are now \n\nA B C D E F G S80  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nessential tools in the management of acute stroke and in selecting those \npatients who are potential candidates for advanced therapies such as \nthrombolysis or thrombectomy.  \nLearning Objectives:\n1. To become familiar with a comprehensive imaging protocol in patients with \nsuspected stroke. \n2. To understand the advantages and limitations of CTA and perfusion in the \ninitial work-up of stroke patients. \n3. To recognise the different imaging patterns in stroke and their prognostic \nvalue. \nA-352 08:58 \nB. Stroke mimickers and pitfalls  \nP. Vilela; Lisbon/PT (ferrovilela@sapo.pt) \n\"Stroke mimic\" is classically used to  describe nonvascular diseases that \npresent with acute focal neurologic deficit corresponding to a consistent \nvascular distribution, which may resemble or may even be indistinguishable \nfrom stoke. It is estimated that up to 15% of stroke-like presentations are due \nto mimickers. There are several neurological  and psychiatric disorders that can \nhave such a clinical presentation, such as seizures and/or postictal status, the \nmost frequent one. The other classical clinical stroke mimickers include: \nmultiple sclerosis, migraine (specially hemiplegic migraine), metabolic \ndisturbances (more commonly hypoglycaemia/hyperglycaemia), intracranial \ntumours or infections and the conversion reactions. Brain imaging plays a key \nrole in the diagnosis and management of acute stroke by differentiating \nischaemic from haemorrhagic lesions, identifying the vessel occluded and \nestimating the viable brain tissue that is at risk for stroke. Imaging is also \nimportant to exclude some of the aforementioned stroke mimics. The more \ncomprehensive stroke imaging protocols, with CT perfusion/angiography \nand/or with MRI, have reduced significantly the misdiagnosis of stroke. MRI-\nDWI is the most sensitive and specific im aging modality for depicting ischaemic \nstroke. However, it is also essential to be aware that there are some \npathological processes that can mimic stroke in imaging studies. These include \nsome disorders that may present themselves with lesions associated with \nrestricted diffusion, like transitory postictal brain abnormalities, migraine and \nencephalitis. The author reviews the most common clinical and imaging stroke \nmimics and highlights the importance of brain imaging in depicting these \nmimickers and avoiding the potential adverse effects of stroke therapy in these \npatients.  \nLearning Objectives:\n1. To learn the differential diagnosis of stroke. \n2. To understand the role of CT and MRI in the work-up of stroke and related \ndisorders. \n3. To recognise imaging patterns that may mimic stroke clinically and \nradiologically. \nA-353 09:21 \nC. Treatment: only intravenous?  \nL. Pierot, S. Soize, S. Emeriau; Reims/FR (lpierot@chu-reims.fr) \nImaging plays a central role in the management of stroke, which is an \nimportant health issue according to the number of patients involved and the \nseverity of the disease. It helps to select patients who will benefit from a \nrevascularisation therapy (IV thrombolysis or endovascular treatment) at the \nacute phase of stroke. If the value of perfusion/diffusion MRI mismatch in the \nevaluation of penumbra is still a matter of debate, other imaging factors are \nassociated with the clinical outcome including  length of clot, Flair positivity, and \ncollateral circulation. If IV thrombolysis using rtPA is still the reference \ntreatment, endovascular treatment is emerging since several years as a \nfeasible and efficacious alternative singul arly since the appearance of stent \nretrievers. Recent neutral randomised trials comparing IV thrombolysis and \nendovascular treatment have shown the critical role of appropriate imaging in \nthe selection of patients who can benefit from acute revascularisation as well \nas the importance of using the most efficacious endovascular devices. \nPrevention of stroke is partially based on the treatment of cervical and \nintracranial stenosis. Several randomis ed trials comparing carotid angioplasty \nand carotid endarterectomy were initially negative, but a recent meta-analysis \nshowed that below the age of 70 years both techniques were equivalent. The \nplace and value of endovascular treatment of intracranial arterial stenosis is \nstill controversial after the publication of the SAMMPRIS results.  \nLearning Objectives:\n1. To understand how imaging can help select patients for intravenous \ntreatment of acute ischemic stroke. \n2. To understand what the current indications are for the endovascular \ntreatment of acute ischemic stroke. \n3. To understand the current role of the endovascular treatment in the \nprevention of stroke. \nAuthor Disclosure:\n L. Pierot: Consultant; Codman, Covidien/EV3, Microvention, Penumbra, \nSequent. \nPanel discussion:  \nWhat is the future of stroke prevention and treatment?  \n09:44\n08:30 - 10:00 Room F1  \nSpecial Focus Session  \nSF 12  \nImaging of thyroid nodules  \nA-354 08:30 \nChairman's introduction  \nT. Beale1, S. Colley2; 1London/UK, 2Birmingham/UK\n(Steve.Colley@uhb.nhs.uk) \nThe management of thyroid nodules has been continuously evolving. I hope \nthat during this session you will understand the important differences in the up-\nto-date national and international guidelines on thyroid nodule management \nand understand the role of the radiologist in the multidisciplinary thyroid \nmeetings. The features that are suggestive of benign, indeterminate and \nmalignant nodules will be demonstrated. Advances in both radiological and \ncytological techniques such as US elastog raphy and BRAF mutation analysis \nthat may help triage patients with thyroid nodules will be covered. The differing \nbiopsy techniques (fine needle aspiration, non-aspiration (FNA and FNNAC) \nand trucut biopsy) and their roles will be highlighted. There will be time for an \nopen question and answer discussion with all the speakers before the end of \nthe session.  \nSession Objectives: \n1. To become familiar with the management of thyroid nodules. \n2. To learn about the imaging features suggestive of both benign and \nmalignant thyroid nodules. \n3. To learn how to optimise imaging of thyroid nodules and the role of newer \ntechniques such as US elastography. \n4. To understand which nodules require FNA/biopsy. \nA-355 08:35 \nManagement  \nT. Beale1, S. Colley2; 1London/UK, 2Birmingham/UK\n(Steve.Colley@uhb.nhs.uk) \nThe management of thyroid nodules and the guidelines of the various \ninterested parties, surgeons, endocrinol ogists, nuclear medicine physicians, \nradiologists and ultrasound specialists, vary across the world, indeed between \ndifferent countries within the EU, and are constantly evolving. I will discuss how \nthe thyroid multidisciplinary meeting (MDT) works at our institution and the role \nof the radiologist in it. The current differing international guidelines on the \nmanagement of thyroid nodules will be mentioned, highlighting their salient \npoints and differences. The role of the di ffering imaging modalities used in the \nmanagement of thyroid nodules will be discussed based on differing clinical \nscenarios. Finally, the management of the common clinical scenario of the \nincidental thyroid nodule will also be discussed.  \nLearning Objectives:\n1. To understand the role of the radiologist as part of a multidisciplinary team. \n2. To learn about current guidelines on the management of the thyroid nodule. \n3. To understand the role of various imaging modalities in the patient with \nthyroid nodule. \nA-356 08:58 \nUS and US elastography  \nA.S. McQueen; Newcastle upon Tyne/UK (andrewmcqueen7@hotmail.com) \nThyroid disease is ubiquitous and usually benign; therefore accurate imaging \nof the thyroid is a major challenge for radiology. Significant advances in \nconventional ultrasonography allow superb visualisation and anatomic \ncharacterisation of thyroid pathology and the impact of broader bandwidths, \nhigher frequencies, spatial compound im aging and novel signal processing \ntechniques will be discussed in this session. The key B mode features of \nthyroid nodules are discussed with reference to relevant clinicoradiological \nguidelines, specific pitfalls and limitations. A significant number of nodules \nremain indeterminate after conventional assessment, and imaging advances \nthat enable more accurate, non-invasive thyroid characterisation are highly \nattractive, potentially reducing unnecessary biopsy and surgery for a large \nnumber of patients. Ultrasound elastography offers a potentially useful adjunct \nto conventional sonography in thyroid disease with a growing evidence base \nindicating that thyroid malignancies are ty pically stiffer than benign lesions and \nthat a 'soft' cutoff value with a high negative predictive value is feasible. \nHowever, elastography studies have included a variety of different techniques, \n\nA B C D E F G S81  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\npatient/nodule selection and assessment methods; therefore the current role of \nelastography will be discussed.  \nLearning Objectives:\n1. To become familiar with the US features of thyroid pathology. \n2. To understand the role of US elastography in thyroid nodules. \n3. To consolidate knowledge on pitfalls in the US assessment of thyroid \nnodules. \nA-357 09:21 \nFine needle biopsy of the thyroid nodule  \nF. Campoy-Balbontín, M.C. Jurado-Gomez; Sevilla/ES\n(fcampoy2000@gmail.com) \nThyroid nodules are very common. The clinical importance of thyroid nodules \nrests with the need to exclude thyroid cancer, which occurs in 5-15%. \nUltrasound (US) has been widely attempted to differentiate benign from \nmalignant nodules and to guide fine needle biopsy (FNB). However, \nconsiderable overlap between benign and malignant characteristics has been \nfound. Nowadays, there are a number of different guidelines for the \nmanagement of thyroid nodules. At our hospital, we have adopted the \nguideline proposed by the Society of Radiologist in Ultrasound (2005). The \ndifferent elements necessary to perform the FNB procedure are demonstrated; \nthe transducer probe, the needles, the slides, the syringe. The way of \nmanaging these elements is shown by figures and videos, with different skills \nand performances to optimise the procedure and get the best sample. US-\ncontrol FNB can be in parallel or perpendicular, both methods are \ndemonstrated. Thyroid FNB is usually non-aspirated, but sometimes it has to \nbe undertaken with aspiration; when and how to change from one method to \nanother is explained. With good technique, the insufficient cytological rate can \nbe significantly reduced, with which the need for core biopsy diminishes. \nAlthough the complication rate for core biopsy is low, FNB is safer and if \nperformed correctly has a high diagnostic yield. Core biopsy should be limited \nto those nodules with a second insuffici ent FNB cytological result, with US \nfindings suspicious for malignancy.  \nLearning Objectives:\n1. To understand when it is necessary to perform a fine needle biopsy of the \nthyroid nodule. \n2. To understand the different techniques used to perform thyroid FN and how \nto optimise them. \n3. To learn when a biopsy may be required. \nPanel discussion:  \nWhat is the role of the radiologist in the management  \nof thyroid nodules?  \n09:44\n08:30 - 10:00 Room F2  \nBreast  \nRC 1202  \nMultimodality breast imaging  \nA-358 08:30 \nChairman's introduction  \nM. Lesaru; Bucharest/RO (mlesaru@hotmail.com) \nMultimodality breast imaging is emerging as radiologists have access to new \ntechnologies coinciding with the refinement of operative techniques. One of the \nchallenges for radiologist remains the correct preoperative staging, especially \nthe metastatic involvement of axillary lymph nodes. Multimodality imaging has \nnew accurate solutions. The imaging follow-up of patients with sophisticated \noncoplastic techniques is another challenge where multimodality breast \nimaging is the solution. Coincident with this increasing contribution to the \ndiagnostic process is the emerging role of the breast imager as a therapeutic \nclinician, making use of innovative image-guided procedures. In this integrated \nRC, experts will present a clinical update on these newer techniques and there \nwill be an opportunity to discuss how the evolution of such techniques is \nchanging the nature of the modern multidisciplinary team meeting.  \nA-359 08:35 \nA. Conventional, functional and interventional lymph node assessment  \nR.M. Pijnappel; Utrecht/NL (r.m.pijnappel@umcutrecht.nl) \nMetastatic involvement of axillary lymph nodes has been known to be one of \nthe most important prognostic factors for women with breast cancer. The \ntraditional approach to staging the axilla is either lymph node sampling \nprocedures or sentinel node biopsy. The main diagnostic features of potentially \nmalignant involvement of the axilla are abnormal lymph node morphology \n(shape and cortical thickness). There has been a concerted effort in recent \nyears to find imaging techniques that might facilitate accurate axillary staging. \nSo far, no imaging technique alone (CT, MRI, scintigraphy and ultrasound) has \nbeen capable of differentiating between po sitive and negative lymph nodes of \nthe axilla in breast cancer. Recent techniques like gadofosveset-enhanced \nmagnetic resonance imaging and high spatial resolution 7-T MRI imaging \nappear promising; however ultrasound-guided sampling of suspicious lymph \nnodes by core or FNA remains the standard of care in assessing the axilla prior \nto treatment planning. Ultrasound-guided axillary lymph node sampling is an \neffective method of assessing the axilla. A recent meta-analysis shows that \nultrasound can be expected to achieve sensitivity approaching 50% for \ndetecting abnormal nodes in those that eventually prove to be nodal metastatic \ndisease. The false-negative rate where biopsy is performed is around 25%. It is \nimpossible to detect the sentinel node by ultrasound alone. Therefore a new \npromising technique was introduced, injecting an ultrasound-contrast agent \naround the nipple. Using this method, it is possible to detect the sentinel node \nin 90% and therefore lower the false-negative rate of US-guided biopsy with \nanother 15%.  \nLearning Objectives:\n1. To learn about normal lymph node morphology. \n2. To understand criteria suggestive of morphological abnormality. \n3. To become familiar with factors affecting overall sensitivity of pre-operative \nlymph node assessment. \nAuthor Disclosure:\n R.M. Pijnappel: Advisory Board; Hologic, without financial reimbursement. \nA-360 08:58 \nB. Multimodality assessment of the breast following oncoplastic surgery  \nM. Torres-Tabanera, S. Pérez-Rodrigo; Madrid/ES\n(mtorrestabanera@gmail.com) \nOncoplastic breast procedures were introduced to fill the gap between \ncomprehensive oncologic surgical treatment of breast cancer and the \nachievement of cosmetic results that fulfill patient expectations in both, body \nimaging and psychological well-being. Due to its complexity and relevance for \nthe patient, the decision of performing these procedures must be made as part \nof the multidisciplinary approach of breast cancer treatment. As a \nconsequence, the role of breast radiologists has expanded beyond the \nanatomic region of the breast and the usual imaging techniques. Basic \nknowledge of the different oncoplastic techniques is mandatory to understand \nthe spectrum of findings from a multi-modality approach. Implants and/or \nautologous reconstruction techniques (pedi cle, free or perforator flaps, as well \nas lipofilling techniques) are widely applied. The role of the radiologist in the \nmultidisciplinary team is twofold: assessment during the planning stage, and \nimaging evaluation at follow-up. The assessment during the planning stage \nincludes the determination of the local extent of the disease that makes the \nchoice of the appropriate surgical technique possible, and the imaging study of \nthe donor site in those cases where autologous reconstruction is elected. \nImaging evaluation at follow-up comprises the recognition of changes and \npotential pitfalls after reconstruction, t he identification of short/mid/long-term \nreconstruction complications, and the detection of recurrent/second \ncarcinomas. Controversial aspects will be reviewed, such as the probability of \nrecurrence after oncoplastic surgery, the need to establish multimodality \nfollow-up protocols and the interrelations between the autologous tissues and \nthe mastectomy bed or remaining breast.  \nLearning Objectives:\n1. To learn about the range of oncoplastic breast procedures in current clinical \npractice. \n2. To become familiar with imaging features resulting from oncoplastic surgery. \n3. To appreciate the potential pitfalls encountered while imaging such cases. \nA-361 09:21 \nC. Image-guided therapy in breast lesions: indications and techniques  \nR.M. Mann; Nijmegen/NL (r.mann@rad.umcn.nl) \nThe use of image guidance for surgical planning has only recently been \naccepted. The use of intraoperative ultrasound in women undergoing \nlumpectomy is associated with a higher rate of negative margins. The \ncombination of image guidance and radiological intervention techniques also \nharbours the possibility of tumour treatment without surgery. Most techniques \nmake use of the placement of needles within the tumour. Treatment is \nperformed by heating, freezing or extracting the tumour tissue. Currently, \nradiofrequency ablation under ultrasound guidance is being furthest evaluated. \nHowever, in RFA even after optical complete tumour ablation, residual vital \ntumour tissue is still found in many cases. This is mainly dependent on tumour \nsize with poorer results (50-60% success rates) in tumour over 2 cm, and \nbetter results (~90% success rate) in smaller tumours. Adequate tumour size \nestimation is thus of vital importance. Currently, since remaining vital cells \ncannot be excluded, the technique is limited to use in patients who cannot \nundergo surgery due to poor health state. Larger series in which RFA is \ncombined with radiotherapy have not been reported. It is therefore not clear \nwhether it is important to actually excise residual vital tumour. Similar \n\nA B C D E F G S82  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nrestrictions currently hold for cryotherapy, laser ablation and hifu. Large \nvacuum-assisted needles and the breast lesion excision system can be used to \nremove the tumour through a minimal incision in the skin. However, margin \nevaluation is difficult. Nevertheless, these techniques are already optional for \nthe removal of high-risk lesions and ca n potentially be combined with (focused) \nradiotherapy.  \nLearning Objectives:\n1. To understand indications for therapeutic interventions in malignant and \nbenign lesions. \n2. To learn about current image-guided therapeutic techniques in malignant \nand benign lesions. \n3. To appreciate potential future developments of therapeutic interventions. \nAuthor Disclosure:\n R.M. Mann: Speaker; Bayer Healthcare. \nPanel discussion:  \nHow is the evolution of multimodality breast imaging changing the nature \nof the multidisciplinary meeting (MDM)?  \n09:44\n08:30 - 10:00 Room G/H  \nGenitourinary  \nRC 1207  \nFemale imaging: how I do it?  \nModerator:  \nV. Panebianco; Rome/IT \nA-362 08:30 \nA. Imaging female congenital anomalies  \nG. Restaino; Campobasso/IT (gennares@hotmail.com) \nThe Müllerian ducts are paired embryologic structures that undergo fusion and \nresorption between the 6 th-11th weeks of gestation to give rise to the uterus, \nfallopian tubes, cervix, and upper two-thirds of the vagina. Non-development, \ndefective vertical or lateral fusion, or resorption failure of the Müllerian ducts \ncan result in formation of Müllerian duct anomalies (MDAs), whose reported \nprevalence ranges between 0.4% and 8%-10%. The classification revised by \nthe American Society for Reproductive Me dicine in 1988 is the most widely \naccepted. Obstructive MDA can occur in infants as palpable pelvic mass, at \nmenarche with cyclic pelvic pain, or pelvic mass, and primary amenorrhea. \nComplications include hematocolpos, hematometra, hematosalpinx, \nendometriosis, pelvic adhesions, and obst ruction of urinary tract. MDAs are \ncommonly associated with renal and other anomalies; thus, identification of \nboth kidneys is important. Accurate diagnosis of an MDA is essential because \nof the high associated risk of infertility, endometriosis and miscarriage, and \nsince the management approach varies depending on the type of \nmalformation. Hysterosalpingography (HSG) is routinely used in evaluation of \ninfertility. Because a key component of MDAs characterisation is the external \nuterine fundal contour, HSG is limited for this purpose. Ultrasonography (US) is \ninitially performed to evaluate uterine anatomy and to assess for associated \nrenal abnormalities. MRI is reserved for complex or indeterminate cases to \ncharacterise the uterine anomaly and evaluate the possibility of a vaginal \nabnormality, or after a seemingly normal US when clinical opinion ensures its \nuse, or to make decisions on management strategies and preoperative \nplanning.  \nLearning Objectives:\n1. To learn about the embryology of normal and abnormal female genital tract. \n2. To understand the role of different available imaging techniques for female \ncongenital anomalies: ISG, TV-US and MRI. \n3. To learn about the examination technique and understand the imaging \nfindings of MRI in the different classes of female congenital anomalies. \nA-363 09:00 \nB. PET-CT in the female pelvis: how I do it?  \nA.G. Rockall; London/UK (a.rockall@imperial.ac.uk) \nThis refresher course will focus on the radiologist's approach to using PET-CT \nwithin the context of the gynaecologic oncology multidisciplinary meeting. The \ncurrent indications for using FDG-PET/CT will be discussed for cervix, \nendometrial and ovarian cancer as well as the potential use of FDG-PET/CT in \nrare gynaecologic cancers. The value of adding FDG-PET/CT to the patient \nmanagement pathway will be presented alongside the potential pitfalls in \ninterpretation as well as controversies. Future developments, including \npotential new tracers, will be mentioned.  \nLearning Objectives:\n1. To understand the role of PET-CT in staging of various pelvic tumours and \ndetection of tumour recurrence. \n2. To learn about the advantages and limitations of PET-CT in imaging the \nfemale pelvis. \n3. To appreciate the role of PET-CT with respect to other imaging techniques \nin the diagnostic algorithms of pelvic tumours. \nAuthor Disclosure:\n A.G. Rockall: Research/Grant Support; Merck and Co. Speaker; Novartis, \nGuerbet. \nA-364 09:30 \nC. How to image cystic tumours of the ovary  \nR. Forstner, M. Meissnitzer; Salzburg/AT (r.forstner@salk.at) \nCystic lesions account for the vast majority of ovarian masses and are \ndetected incidentally in 5-18%. Their spectrum ranges from non-neoplastic \ncysts to benign tumours, e.g. cystadenomas and dermoids to the rare ovarian \ncancer. Diagnostic criteria in US, CT and MRI are based on the clinical \nbackground (age, menopausal status, medical history, and tumour markers) \nand the morphology of the ovarian mass. Typical of a benign cystic lesion is its \npure cystic structure or thin septations, fatty or haemorrhagic contents, and \nmild enhancement of solid components in a complex solid and cystic ovarian \nmass. Thus, patients can be categorised into 3 different risk groups. \nSonography has been established as the first-line imaging modality to assess \nthe ovaries. Recently, management guidelines have been adopted for cystic \novarian lesions. In these guidelines, also cystic adnexal incidentalomas are \nincluded. MRI is most useful as a complementary technique in sonographically \nindeterminate masses. An algorithmic approach will render a specific diagnosis \nin the vast majority of cases. In complex cystic lesions, integration of DWI and \ndynamic contrast-MRI allows differentiation of rare benign complex tumours, \ne.g. cystadenofibroma from ovarian cancer. Pitfalls of cystic ovarian tumours \ninclude cystic fibroids, peritoneal cy sts, and extraperitoneal cystic tumours. \nCompared to US, both CT and MRI are superior in assessing large cystic \npelvic masses. Criteria to differentiate between intra- and extraperioneal origin \ninclude displacement patterns and identi fication of the vascular pedicle. Careful \nanalysis of imaging and clinical findings usually allows differentiation of \ninflammatory tumours from ovarian cancer.  \nLearning Objectives:\n1. To learn about specific imaging algorithms of ovarian cystic tumours. \n2. To understand certain imaging features that can differentiate ovarian from \nnon-ovarian cystic tumours in the pelvis. \n3. To become familiar with the pitfalls in imaging of ovarian cystic tumours and \nthe lessons to be learned from them. \n08:30 - 10:00 Room I/K  \nHead and Neck Imaging  \nCC 1219  \nWhat do I see? Clinical radiological \ninteraction (part 1)  \nModerator:  \nS. Robinson; Vienna/AT \nA-365 08:30 \nA. Temporal bone: conductive hearing loss and cholesteatoma  \nB. De Foer, F. Offeciers; Wilrijk-Antwerp/BE\nThe diagnostic methods available in pati ents with conductive hearing loss are: \npersonal and family history, otoscopy, audiology, imaging, surgical inspection \nand counseling. The most important reasons for imaging are: atypical history, \nsuspicion of congenital hearing loss, suspected otoscopic image, asymmetric \nbone conduction thresholds, profound mixed hearing loss and suspected \ntympanometry. CT can be used to detect otosclerosis, tympanosclerosis, \nposttraumatic ossicular lesions, superi or semicircular canal dehiscence and \ncholesteatoma. MRI can be used to exclude schwannoma, congenital \ncholesteatoma and residual and recurrent cholesteatoma after prior surgery. \nThis lecture will illustrate the value of CT and MRI in the evaluation of \ncholesteatoma patients as well as prior to first stage surgery and prior to \nsecond look surgery. Different subtypes of surgery will be highlighted and \nillustrated. The growing importance of MR imaging and diffusion weighted \n(DW) imaging in particular will be illustrated in the evaluation of cholesteatoma \npatients. The role of echo-planar and non-echo-planar DW imaging will be \ndiscussed as well as the eventual use of delayed gadolinium-enhanced T1-\nweighted imaging.  \n\nA B C D E F G S83  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To become familiar with pathologies causing CHL. \n2. To understand what the clinician needs in order to perform surgery. \n3. To learn about possible pitfalls and complications. \nA-366 09:00 \nB. Temporal bone: sensorineural hearing loss and deafness  \nJ. Casselman1, F. Offeciers2, B. De Foer2; 1Bruges/BE, 2Antwerp/BE\nMR is the modality of choice in patients with congenital or acquired \nsensorineural hearing loss (SNHL) and the complete auditory pathway from the \ncochlea to the auditory cortex must be studied in these patients. The labyrinth, \ninternal auditory canal (IAC) and cerebellopontine angle (CPA) are best \nstudied using submillimetric heavily T2W images, showing the intralabyrinthine \nfluid and nerves. But submillimetric Gd-enhanced T1W images or 3D-Flair \nimages remain more sensitive. The auditory pathway in the brainstem is best \nstudied with a multi-echo sequence (m-FFE/medic/merge) or T2W TSE \nsequence and the auditory cortex is best studied on T2W TSE images. The \nclinical information provided by the otologist will direct the radiologist to a \ncertain part of the auditory pathway or will let him use certain imaging \ntechniques. For instance, congenital malformations in the labyrinth and IAC \nmust be excluded in case of congenital SNHL, and in case of mixed hearing \none will start with CT to exclude otosclerosis. The most frequent pathology in \nthe labyrinth (labyrinthitis, intralabyrinthine schwannoma, congenital \nmalformation, post-traumatic lesions), the IAC and CPA (cochleovestibular \nschwannomas, meningiomas, epidermoid tum ours and facial nerve neuritis) \nand central auditory pathway (MS, infarction, tumor and trauma) will be \nillustrated using clinical examples and the important \"otologist-radiologist\" team \nwork will be stressed.  \nLearning Objectives:\n1. To become familiar with causes of SNHL and diagnostic possibilities. \n2. To learn which pathologies can be successfully treated and what information \nis needed from the radiologist. \n3. To learn about interesting cases highli ghting the role of diagnostic imaging in \ntreatment planning. \nA-367 09:30 \nC. Laryngeal and hypopharyngeal cancer  \nR. Maroldi, P. Nicolai; Brescia/IT \nFor tumours that nearly always arise from the investing mucosa, like in the \nlarynx and hypopharynx, it is endoscopy that directly maps the superficial \nextent and grades the functional impairment (arytenoid and vocal cord \nmovement, pyriform sinus distensibility). In addition to white light, the recent \nuse of narrow band imaging endoscopic technology, enhancing fine capillaries \nin the mucosal surface, enables the detection of neoangiogenesis caused by \nearly squamous cell carcinoma. Conversely, submucosal spread is the domain \nof cross-sectional imaging techniques. Therefore, it is the integration of the two \nclasses of data, along with the information about patient conditions, which \npermits the choice of the most proper treatment strategy. In early and \nadvanced glottic cancer, treatment planning  is modulated by information about \ndeep neoplastic invasion into the paraglottic space, the cartilage or the supra-\nsubglottis subsites. This information can be derived by discriminating the \ntumour tissue from intra-laryngeal muscles, fat spaces and the cortical rim of \nossified cartilages. Though MR shows a greater contrast resolution than CT, it \nis hampered by a significantly longer acquisition time. This means more \nartefacts caused by breathing and movement. Nevertheless, MR has the \npotential to unravel the signals from  submucosal tissues, separating tumour \nfrom oedema, muscles, fat and ossified cartilages. Advanced laryngeal and \nhypopharyngeal cancers need to preliminary assess local (nodes) and distant \n(metastases) spread. CT-PET is the more accurate tool. The multidisciplinary \napproach to the processing of the whole frame of data is essential to offer the \npatient the best care.  \nLearning Objectives:\n1. To learn about different types of laryngeal cancer and treatment options. \n2. To understand the role of diagnostic imaging in treatment planning. \n3. To review clinical cases in order to highlight the role of clinical-radiological \ncooperation. \n08:30 - 10:00 Room L/M  \nPhysics in Radiology  \nRC 1213  \nCone-beam CT  \nModerators:  \nD. Bor; Ankara/TR \nS.J. Golding; Oxford/UK \nA-368 08:30 \nA. Fundamentals of cone-beam CT  \nM. Kachelrieß; Heidelberg/DE (marc.kachelriess@dkfz.de) \nTraditionally, x-ray CT scanners were equipped with a single or a few detector \nrows only, image reconstruction was assuming parallel slices, which was a \ngood approximation for these fan-beam systems. About a decade ago the \nnumber of slices increased to 16 or more and the parallel slice approximation \nwas no longer valid. The cone-beam nature of these multi-slice CT (MSCT) \nscanners had to be taken into account by specific cone-beam reconstruction \nalgorithms. While these MSCT systems - today they are simultaneously \nacquiring up to 320 slices - are cone-beam CT systems in a general sense, the \nnotion of cone-beam CT (CBCT) is also associated with a specific kind of cone-\nbeam CT, namely those equipped with flat detectors, i.e. the non-diagnostic or \nnon-clinical CT systems. MSCT, in contrast, is a cone-beam CT system for \ndiagnostic use, i.e. a clinical CT system. This distinction between MSCT and \nCBCT is useful, as there are decisive differences in application, performance, \nand in image reconstruction. These differences will be reviewed in the \npresentation, with a particular focus on why image quality in MSCT is so much \nbetter than in CBCT.  \nLearning Objectives:\n1. To understand the principles of volumetric image formation with flat \ndetectors. \n2. To understand the difference between CBCT and MSCT. \n3. To learn about reconstruction techniques and image processing. \n4. To become acquainted with the important image quality parameters. \nA-369 09:00 \nB. Medical applications of cone-beam CT  \nM. Grass; Hamburg/DE (michael.grass@philips.com) \nCone-beam (CB) imaging with flat detectors is performed on a variety of \ndifferent imaging systems. The most important area is CB imaging using \ninterventional C-arm systems. The minimally invasive procedures carried out \non these systems benefit from the availability of high-resolution 3D images for \nintervention planning, guidance and outcome control. Interventional CB \nimaging was first applied in neuroradiology using rotational angiography \nacquisitions. Today, it is used for a variety of procedures in interventional \nradiology, cardiology and oncology ba sed on angiographic and soft tissue \nprotocols. One of the inherent advantages of this approach is the direct \nregistration of the volume images into the interventional procedure. Other \napplication areas of CB imaging using different scanning systems are onboard \nimaging in radiation therapy or the integration of flat detector tomography and \nSPECT. This part of the course teaches the generation of 3D volume \ninformation from flat detector systems and its utilisation in different clinical \napplications. Image acquisition protocols, scan modes, and system design \nparameters are explained. Application-specific calibration and processing steps \nare introduced to show how CB imaging is tailored for specific clinical \napplications. Examples are presented for angiographic and soft tissue \nvolumetric imaging. Medical applications utilising the tomographic images for \ndiagnosis, intervention planning, guidance, or outcome control are discussed.  \nLearning Objectives:\n1. To become acquainted with the applications of CB imaging. \n2. To learn about systems design and parameters. \n3. To understand image quality characteristics. \n4. To learn how to use cone-beam images in image-guided interventions. \nAuthor Disclosure:\n M. Grass: Employee; Philips Research. \nA-370 09:30 \nC. 3D dentomaxillofacial imaging  \nK. Horner; Manchester/UK (keith.horner@manchester.ac.uk) \nIn the last decade, three-dimensional dentomaxillofacial imaging through cone-\nbeam CT (CBCT) technology has become widely available. Dental CBCT \n(digital volumetric tomography; DVT) equipment is compact and often \naffordable to dentists. The driver for dental  CBCT was implant dentistry, but its \nuse has spread to other areas, including paediatric applications. Radiation \ndoses are variable. Some systems offer a fixed, large, field of view and others \n\nA B C D E F G S84  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nfixed exposure factors, obstructing attempts at optimisation. Typically, doses \nare at least an order of magnitude greater than for \"conventional\" imaging. \nImage quality is also variable, which means that certain equipment may be \nunsuitable for some clinical applications. There is often scope for lower \nexposure factors to be used than those recommended by manufacturers. A key \naspect of using CBCT relates to justification. Imaging in three dimensions may \nbe perceived by dentists as inevitably superior, a view which is often implicitly \nencouraged by those selling equipment. The research on diagnostic efficacy is, \nhowever, limited. In 2012, the European Commission published \"Radiation \nProtection 172: Evidence-based Guidelines on Cone Beam CT for Dental and \nMaxillofacial Radiology\". This provides a comprehensive set of \nrecommendations, including referral criteria, a quality assurance programme \nand optimisation strategies. Priorities for future research relate to exposures to \nthe necessary image quality requirements for specific clinical applications, \nalong with research on the impact on clinical outcomes of CBCT-based \ntreatments. It is clear that much work remains before the place of CBCT in \ndentistry can be established.  \nLearning Objectives:\n1. To become acquainted with CBCT systems for dentomaxillofacial imaging. \n2. To learn about image quality characteristics and patient dose compared with \nother techniques. \n3. To learn how to access CB images and influence the clinical outcome. \n08:30 - 10:00 Room N/O  \nInterventional Radiology  \nRC 1209  \nThoracic nonvascular interventions  \nA-371 08:30 \nChairman's introduction  \nO. Akhan; Ankara/TR (akhano@tr.net) \nThe role of nonvascular interventional radiology of thorax for both diagnosis \nand treatment has significantly increased in the last 20 years. Although these \nprocedures are technically easy with highly successful results, thoracic \nnonvascular interventional procedures are not unfortunately routinely \nperformed in all of the interventional units. The most commonly performed \nprocedures generally under CT guidance are transthoracic biopsies of the lung, \nmediastinal lesions and pleura. The others include percutaneous drainage of \nthoracic collections such as pleural effusions, empyema and mediastinal \ncollections. Image-guided tumour ablation performed by either radiofrequency \nablation (RFA) or microwave (MW) as a nonvascular thoracic intervention has \nbecome a serious treatment alternative in patients with lung tumours (either \nnon-small cell lung cancer or lung metastasis) since the year 2000. \nInterventional radiologists are expected to understand the clinical indications of \nthese procedures at the first step. In addition, the techniques of the procedures \nand possible risk of complications in their management methods should be \nlearnt by interventional radiologists as well. This refresher course will help us to \ndiscuss the main indications, techniques and complication management of \nthese procedures.  \nA-372 08:35 \nA. Lung biopsy  \nT. Sabharwal; London/UK (Tarun.Sabharwal@gstt.sthames.nhs.uk) \nLung biopsy is most commonly now performed under CT guidance. It has a \nhigh technical success rate. Common complications include pneumothorax, \nbleeding, sepsis, pain and failure. Air embolism is a rare complication. PET \nscan is a useful tool to guide for appropriate target. Ultrasound is useful for \nbiopsying pleural-based lesions.  \nLearning Objectives:\n1. To understand the role of lung biopsy. \n2. To learn how to properly plan a lung biopsy. \n3. To understand common complications and their management. \nA-373 08:58 \nB. Percutaneous drainage of thoracic fluid collections  \nI. Vollmer; Barcelona/ES (ivollmer@hospitaldelmar.cat) \nDrainage of thoracic fluid collections is a relative emergency. We will review \nthe different thoracic fluid collections that can be drained by radiologists: \npleural (parapneumonic, empyema, and malignant effusions), mediastinal, \nchest wall, pulmonary (lung abscesses and infected tumours) and pericardial \neffusions. We will answer the following questions about the main thoracic fluid \ncollections: how to diagnose, when and how to drain, which guidance \n(ultrasound or CT-fluoroscopy), and procedures to perform before and after the \ndrainage. The choice of imaging to detect thoracic fluid collections and guide \ndrainage depends on the availability of the modalities, the imaging \ncharacteristics, location of the collection, and the comfort and expertise of the \noperator with the specific modalities. We will also review the main \ncomplications of percutaneous drainage of thoracic fluid collections \n(pneumothorax, pain, drain dislodgement and drain blockage) and compare \nthese complications with those related to large-bore chest catheters inserted \nby thoracic surgeons.  \nLearning Objectives:\n1. To learn the imaging features of thoracic fluid collections. \n2. To learn when and how to drain thoracic fluid collection. \n3. To understand patient management. \nA-374 09:21 \nC. RFA of lung tumours  \nP.L. Pereira; Heilbronn/DE (philippe.pereira@slk-kliniken.de) \nThe incidence of lung cancers continues to increase and primary lung cancer \nremains the leading cause of cancer-related deaths in both women and men. \nTherapy of lung tumours includes resection, radiation therapy, chemotherapy, \nthermal ablation or a combination of these treatment modalities. Image-guided \npercutaneous thermal ablation therapies are minimally invasive techniques \nestablished in the local treatment of hepatic, renal, or osseous tumours. \nAmong these techniques, radiofrequency ablation (RFA) has now attained \nconsideration for therapy of small pulmonal tumours. Other ablation techniques \nthat have been used for treatment of lung tumours include cryoablation, laser \n(LITT) and more recently microwave ablation (MWA) and irreversible \nelectroporation (IRE). Ablative techniques may produce a complete and \nirreversible tumour tissue destruction through application of either hot or cold \nthermal energy, or through permeabilisation of the cell membrane while using \nIRE. CT is currently the imaging modality that is most widely used for planning, \nmonitoring the ablation's course and for assessment of treatment response. \nOnly patients with stage I and stage II lung cancer and those with small \nmetastases are potential candidates for ablation. The medical history and \nphysical examination of the patient as well as recent imaging with CT should \nbe evaluated to determine the indication for thermal ablation. Percutaneous \nlung RFA is considered as a safe procedure with an overall morbidity rate from \n15.2% to 55.6% and mortality rate from 0% to 5.6%; it requires less costs and \noffers faster recovery, and reduced morbidity and mortality.  \nLearning Objectives:\n1. To learn about the best indications for RFA in comparison to other treatment \noptions. \n2. To appreciate the imaging problems during and after lung ablation. \n3. To learn about outcome after RFA. \nAuthor Disclosure:\n P.L. Pereira: Advisory Board; Terumo. Consultant; Terumo. Research/Grant \nSupport; Celon Olympus, Siemens Medical Solutions. Speaker; \nAngiodynamics, Terumo. \nPanel discussion:  \nIs there a role for other imaging modalities besides CT?  \n09:44\n08:30 - 10:00 Conf. Room M3  \nOncologic Imaging: Follow-up of Systemic and Local Therapies  \nCC 1218  \nAssessing HCC response to …  \nModerator:  \nC. Bartolozzi; Pisa/IT \nA-375 08:30 \nA. Systemic therapies  \nV. Vilgrain, M. Ronot, M. Zappa, S. Faivre, E. Raymond; Clichy/FR\n(valerie.vilgrain@bjn.aphp.fr) \nSorafenib, a tyrosine kinase inhibitor, has shown clinical efficacy in patients \nwith hepatocellular carcinoma (HCC) and is the standard of care for patients \nwith advanced-stage HCC. Nowadays, many targeted therapies are evaluated \nin HCC either as sole treatment or in combination with other treatments such \nas tumour ablation, chemo-embolisation, and surgical resection. Therefore, \nthere is a need to assess the efficacy of targeted therapy in HCC. RECIST is \nthe reference method to evaluate treatment efficacy in solid tumours, but does \nnot seem appropriate in evaluating targeted therapy as objective responses \nare seen in very few cases in patients treated with sorafenib or sunitinib. New \ncriteria have been proposed to evaluate the treatment efficacy of nonsurgical \ntreatments in patients with HCC. The most common ones are the Choi criteria, \nthe EASL criteria, and the modified RECIST criteria. All these criteria mainly \nfocus on internal tumour changes such as appearance of necrosis or \ndisappearance ot tumour hypervascularity. Many examples will be shown \n\nA B C D E F G S85  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nduring the lecture. Another approach is based on functional imaging and \nespecially perfusion-related imaging. Contrast-enhanced ultrasound, CT \nperfusion and dynamic contrast-enhanced MR imaging have the capability to \nassess perfusion changes in patients under treatment. The advantages and \ndisadvantages of these modalities will be discussed. Lastly, other functional \ntools that are not routinely used will be presented.  \nLearning Objectives:\n1. To learn about difficulties in HCC assessment with local therapy. \n2. To become familiar with various evaluation criteria of HCC. \nA-376 09:00 \nB. Endovascular therapies  \nR. Lencioni; Pisa/IT (riccardo.lencioni@med.unipi.it) \nTumour response in oncology is usually measured according to Response \nEvaluation Criteria in Solid Tumors (RECIST). The RECIST model - developed \nin 2000 and revised in 2009 with the publication of the version 1.1 - was \ndesigned for evaluation of cytotoxic agents. It offers a simple approach to \ndetermining anatomic size and lesion changes during treatment as an indicator \nof response. However, it does not address measures of antitumour activity \nother than tumour shrinkage and was shown to be unable to capture the \nanticancer activity of tumour-directed therapies used in the treatment of HCC, \nsuch as transarterial chemoembolisation (TACE) and radioembolisation. Given \nthe poor correlation observed between response evaluation by conventional \nmetrics and overall survival, a group of experts in HCC clinical trials convened \nby the American Association for the Study of Liver introduced the concept of \nviable tumour in HCC response assessment, and proposed specific \namendments to standard RECIST. The resulting criteria were named modified \nRECIST (mRECIST) for HCC. The mRECIST criteria have been endorsed by \nseveral scientific societies and organisations and have been increasingly used \nin HCC clinical research. A growing body of scientific evidence suggests that \nmRECIST- designed for response assessment in clinical trials - may translate \ninto a tool for clinical practice.  \nLearning Objectives:\n1. To appreciate the value of different imaging techniques for assessment of \nintra-arterial HCC therapies. \n2. To become familiar with post-treatment imaging after intra-arterial therapies \naccording to type of therapy. \nA-377 09:30 \nC. Ablative therapies  \nC. Ayuso; Barcelona/ES (cayuso@clinic.ub.es) \nThe evaluation of treatment efficacy is a key issue with prognostic and patient \nsurvival implications. It is crucial to have obj ective and reproducible criteria for \nspecific groups of patients. The goal of ablative therapies of HCC is to induce \ntumoural tissue destruction. Complete response (CR) after initial chemical and \nthermal percutaneous ablation, defined as the absence of contrast \nenhancement of the treated tumour at CEUS, dynamic CT or dynamic MR, has \nbeen reported to correlate to long-term survival. Nevertheless, the clinical \neffectiveness of imaging techniques to assess initial treatment success differs \naccording to tumour size. The success rate of RF has been demonstrated to \nbe superior to PEI in HCCs > 2 cm, and depends on the ability to ablate all \nviable tumour tissue including an adequate tumour-free margin all around the \nlesion of 0.5 to 1 cm. Thus, the effectiveness of RF directly depends on the \ntumour location and size. RF is considered an effective treatment in lesions \u0001\n3 cm and its effectiveness is progressively reduced along with tumour size and \nit is not effective in lesions > 5 cm. CEUS beyond 1 month may confirm or \ndetect residual tumour, deserving a fi nal ablation procedure. CT and MR are \nmore effective in the follow-up to confirm CR and detect local recurrence, or \nadditional HCC lesions in the liver parenchyma. The presence of transient \nhyperaemic inflammatory changes in the periphery of the treated area is a \ncommon finding that should be considered to avoid overestimation of the \nrecurrence rate.  \nLearning Objectives:\n1. To learn about the value of different imaging techniques for the assessment \nof ablative HCC therapies. \n2. To become familiar with post-treatment imaging after ablative therapies \naccording to type of therapy. \n08:30 - 10:00 Board Room A  \nRadiographers  \nRC 1214  \nHow important are state-of-the-art displays \nto radiology?  \nA-378 08:30 \nChairman's introduction  \nC. Vandulek; Kaposvár/HU (cvandulek@gmail.com) \nOne of the major characteristics of medical imaging in the twenty-first century \nis the dramatic influx of novel technology. This impact of new technology and \ntechniques is experienced in all imaging modalities. The continuous \ndevelopment and implementation of highly sophisticated medical products and \ndevices is key to the evolution of medical imaging leading to the improvement \nof patient care in terms of quality and positive outcomes. This session will \nanalyse state-of-the-art displays (monitors, smartphones, tablets) and their \napplications in modern imaging. The session will provide a brief overview of \ndisplays in the current imaging chain. It will then evaluate the various \nspecifications and parameters associated with displays. The session will \nevaluate current QA standards of modern displays as well as the challenges \nsurrounding such novel technologies.  \nSession Objectives: \n1. To appreciate the technical paramet ers associated with display devices and \nwhy we need to be familiar with them. \n2. To consider the evolution of display devices since the introduction of digital \nimaging techniques. \nA-379 08:35 \nA. Primary class displays  \nW.A. Hummel; Leeuwarden/NL (willy.hummel@kcl.znb.nl) \nImage quality can be described in terms of resolution and contrast. An image \ndisplayed on a monitor consists of di fferences in brightness. The display \nmonitor is at the end of the image chain in radiology, which starts at the X-ray \ntube. There are several factors in this chain that have influence on the contrast \ndisplayed on the monitor. Diagnostic image quality can be described as \nobserved contrast, which is not only dependent on the displayed image, but is \nalso influenced by ambient conditions. For the primary class displays, typical \ncharacteristics of display monitors; such as resolution, homogeneity, \nluminance, contrast, monochrome or color, must be appropriate for the \nradiologist to execute a reliable diagnosi s. Calibration of display monitors is \nalso important. Which parameters are significant and what is the effect of \nvariation of these parameters. There are standards like DICOM GSDF and \ntechnical standard from ACR-AAPM-SIIM.  \nLearning Objectives:\n1. To understand the range of display devices currently on the market for \nmedical imaging purposes. \n2. To explore current legislation and guidelines related to the use of display \ndevices in radiology. \n3. To become familiar with current legislation and guidelines on quality control \nand quality assurance procedures. \nA-380 08:58 \nB. Is a smartphone all that is required?  \nR. Toomey; Dublin/IE (rachel.toomey@ucd.ie) \nBoth within and outside the clinical environment, the use of smartphones and \ntablet computers is increasing. Reported applications range from teaching and \neducation to navigation in surgical procedures. Interest in the use of \nsmartphones and tablets for viewing radiological images has been growing. \nHowever, these portable displays can di ffer significantly from conventional \nradiological displays. In order to determine where and how smartphones and \ntablets can be used appropriately, it is important to understand these displays \nand the challenges associated with them. This presentation will outline the \ncurrent and potential uses of smartphones and tablet computers in radiology \nand compare their performance with other radiological displays and standards. \nThe possible limitations/benefits of smartphones and tablets as display devices \nfor radiological images will be discussed. Recent research in the field will be \nreviewed, with emphasis on studies of diagnostic efficacy.  \nLearning Objectives:\n1. To become familiar with the growing evidence base that both supports and \nopposes the use of hand-held display devices in medical imaging. \n\nA B C D E F G S86  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n2. To learn about ongoing developments in radiology display devices and \nwhether or not these can currently be justified. \n3. To learn about examples of appropriate and inappropriate use of state-of-\nthe-art-display devices in radiology. \nA-381 09:21 \nC. Clinical requirements for image display  \nD. Pekarovic, U. Zdešar; Ljubljana/SI (dean.pekarovic@kclj.si) \nIn modern clinical environment, diagno stic monitors have replaced glowboxes \nand films and have become an important part of the imaging chain. The \nrequired specifications and the quality of monitors largely depend on their \npurpose, beginning from quite simple monitors used for the preview of \nradiographic images placed on modality or in control room to monitors used by \nhigh-end diagnostic workstations. Decision about the kind of monitor for certain \nworkplace is also very important from the economic standpoint as there are \nlarge differences in their prices. Beside s monitor specifications, also ambient \nconditions and ergonometry in the reading rooms are also very important \nissues which need to be considered to ensure optimal environment for clinical \nimage reading. Some of good and bad examples will be given in the \npresentation. As with other radiological equipment, also diagnostic monitors \nneed to be controlled to ensure their optimum performance. Quality control \nbegins with monitor acceptance testing and setting up measurement \nparameters which are to be followed. Practically all monitor vendors include \nsome QC software within their workstations which can, together with some \nindependent measurements, form an efficient quality control programme. In the \nlast steps, how to deliver all information regarding image quality and possible \npresets on the diagnostic monitor and how not to confuse the user are \nimportant.  \nLearning Objectives:\n1. To become familiar with clinical requirements in terms of the primary class \ndisplays used. \n2. To appreciate the practical steps involved in the implementation of a quality \nassurance programme for radiology displays. \n3. To understand the key considerations in evaluating the appropriateness of \ndisplay devices. \nPanel discussion:  \nThe pros and cons of cutting-edge display devices  \n09:44 \n 08:30 - 10:00 Room P  \nEDiR Workshop  \nEuropean Diploma in Radiology: what a \nhearty meal!  \nA-382 \nAppetiser: what is behind the curtain  \nY. Menu; Paris/FR \nSitting an examination is always a source of anxiety. The EDiR exam is no \nexception. This workshop is dedicated to those who want to take the EDiR \nexam, or become examiners, and would like to learn more about its format and \ndiscover some tips and tricks. The EDiR organisers and examiners have \ndecided to build an interactive, friendly and enjoyable session in order to teach \nthe essentials. Some will play the role of the examiners, some the role of the \ncandidate. In order to simulate the candidate's experience, this session will \nhave no safety net. Some senior members will expose themselves to real \ndifficult questions in general  radiology. Fortunately, we hope that the attendees \nwill be able to help the \"candidates\" to succeed. Hopefully, you will enjoy this \nsession and get some very useful information for your EDiR exam.  \nA-383 \nPièce de résistance: live EDiR performance  \nL. McKnight1, J. Vilar2, Y. Menu3; 1Langland/UK, 2Valencia/ES, 3Paris/FR  \nA-384 \nCatch of the day: fun and nasty tricks to succeed or to fail  \nS. Barter1, W. Schima2, L.E. Derchi3, M.M. Thurnher2; 1Cambridge/UK,\n2Vienna/AT, 3Genoa/IT\nA-385 \nNightcap: the EDiR tomorrow  \nY. Menu; Paris/FR\n10:30 - 12:00 Room B  \nESR meets Mexico  \nEM 4\nOncology imaging in Mexico  \nWelcome by the ESR President  \nG. Frija; Paris/FR \nPresiding:  \nC. Rodríguez Treviño; Mexico/MX \nV.E. Sinitsyn; Moscow/RU \nJ. Tanus Hajj; Mexico/MX \nA-386 10:30 \nIntroduction  \nC. Rodríguez Treviño, J. Tanus-Hajj; Mexico/MX\nThe Mexican Society of Radiology and Imaging, SMRI, was the first radiology \nsociety in the country. It was constituted in 1926, first as Mexican Society of \nElectroradiology, and in 1942 transformed to Mexican Society of Radiology; \nadding Imaging in the first years of 1970. The Mexican Federation of Radiology \nand Imaging, FMRI, was established in 1972 and is constituted by all the 32 \nnational radiology societies. Simultaneously, the Mexican Board of Radiology \nbegan to work in relation to radiologist´ s certification. The presidents of these \ninstitutions have a two-year term. As presidents of SMRI and FMRI, we \nmention our appreciation for the invitation to the European Congress of \nRadiology-European Society of Radiology so that our institutions can \nparticipate in this important programme: ECR Meets Mexico. Since our Society \nand our Federation were established many decades ago, among our main \nobjectives have been promoting continual medical education in radiology and \ncontributing to the development of standards of excellence and reliable and \npersonalised radiology in a framework of professionalism. For some years, we \nhave had the support of radiologist members of ESR-ECR in Mexican courses, \nacademic meetings and congresses. The last International Congress of \nRadiology was set in Cancun, Mexico, in 2002, and was organised by FMRI in \nconjunction with the International Society of Radiology, ISR, and the European \nSociety of Radiology. For this and other academic support, we also want to \nexpress our special thanks.  \nSession Objectives: \n1. To express our appreciation to the ECR for inviting Mexico to participate. \n2. To learn about Mexican radiology organisations. \n3. To learn about Mexico's participation in international radiology meetings. \nA-387 10:35 \nAbdominal imaging in oncology  \nL.A. Sosa-Lozano; Mexico City/MX (antonsosarad@gmail.com) \nAbdominal malignancies are an important health problem in Mexico. Like in \nmany other middle-income countries, there has been an epidemiological \ntransition with an overall increase in oncologic diseases. Colorectal, gastric \nand liver carcinomas are some of the frequent abdominal malignancies. \nColorectal cancer is a disease that is curable if detected early and even \npreventable if precursor polypoid lesions are removed. Imaging plays a critical \nrole in staging at diagnosis. Additional ly, virtual colonoscopy is an accepted \nmodality in cancer screening. High-resolution magnetic resonance imaging \n(MRI) has become a pivotal modality in the pretreatment assessment of rectal \ncarcinoma. Computed tomography (CT) is an excellent modality in the \npreoperative staging of gastric cancer and follow-up after treatment. Positron \nemission tomography (PET) combined with CT (PET/CT) is particularly helpful \nfor gastric and colonic carcinoma staging. Hepatocellular carcinoma (HCC) is \nalso common. Cirrhosis related to alcohol  and hepatitis C infection are by far \nthe commonest aetiologies. Ultrasound (US) in conjunction with alpha-protein \nis the most widely used modality for screening purposes. CT and MR are \nconfirmatory modalities. The advent of hepatospecific gadolinium contrast \nagents has been very helpful in the characterisation of focal lesions in cirrhotic \npatients. The use of multidetector CT (MDCT) in pancreatic carcinoma for the \ndetection of vascular and adjacent organ invasion is crucial in treatment \nplanning. Over the last few decades, there has been an important improvement \nin imaging techniques resulting in better quality images. Imaging is critical not \nonly for the diagnosis, but also for treatment planning and follow-up.  \nLearning Objectives:\n1. To learn about the imaging of common oncologic gastrointestinal diseases. \n2. To understand the importance of imaging in liver and colon cancer. \n3. To learn how imaging supports oncologic institutions. \n\nA B C D E F G S87  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-388 10:55 \nInterlude: Meet Mexico  \nJ. Ramírez-Arias; Mexico/MX (jlramirez.arias@saludangeles.com) \nThe presentation has the objective of giving the audience a synthesised \npanorama of our country situated in North America, with more than 110 million \ninhabitants and a large prehispanic history based on the Aztec, Toltec and \nMaya cultures, and also of interesting facts related to the three centuries of \ncolonial existence under the Spain influence and dominium until the 1810 war \nof Independence. After 1880, Mexico has never had an international war; the \nlast was against the northern border country, the United States. Also, we will \ngive important data on how in 1910 the Mexicans rebelled against a 30-year \ndictator, General Porfirio Diaz. The Mexican Revolution was a long and cruel \nwar, but later opened the doors to democracy and a complex developmental \nera began that is still in process. Some demographic and contributions to \nhealth, science and culture issues will be mentioned and also the works of \nMexican scientists, writers and philosophers who have been presented awards \nincluding the Nobel Prize. In relation to well-known Mexican artists such as \nDiego Rivera and Frida Khalo, some facts of their works will be presented.  \nLearning Objectives:\n1. To learn some Mexican history. \n2. To learn about the demographics of Mexico. \n3. To learn about Mexican culture in the 2 1\nst century. \nA-389 11:00 \nInterventional radiology in oncologic patients  \nG. Elizondo-Riojas; Monterrey/MX (elizondoguillermo@hotmail.com) \nInterventional radiology (IR) is becoming an increasingly prominent \nsubspecialty in the care of oncologic patients. Its role extends from initial \ndiagnosis to minimally invasive treatment of the malignancy and its \ncomplications. Image-guided biopsies are increasingly performed using \nminimally invasive techniques. Also, an integral part of care of these patients is \nvascular access as a means of medication, chemotherapy or parenteral \nnutrition, and interventional radiologists can place required the devices with \nwell-established safety and efficacy. IR also plays a substantial role in the \ntherapy of oncologic patients, through local tumor treatments such as \ntransarterial chemo-embolisation and locoregional control with \nradiofrequency/cryo ablation, as well as management of complications of \nmalignancy such as pain, obstruction (biliary, ureteral, etc)., venous thrombosis \nand drainage of thoracic and abdominal collections. In Mexico, IR is a growing \nsubspecialty, and more medical students nowadays want to be radiologists and \neventually become interventional radiologi sts. This is a paradigm shift. More \nand more radiologist wants to be involved with patient management and to be \nmore than just \"observers\" in the process of patient care. We have to be \nprepared to offer this opportunity to our residents; otherwise other specialties \nwill \"have to fill the empty space\" that we have left. Interventional oncology has \nall the advantages to fulfil this opportunity. It is our chance to contribute to the \nadvancement of medical care.  \nLearning Objectives:\n1. To appreciate the role of interventional radiology in the management of \noncologic patients. \n2. To learn how interventional radiology changes the quality of life for patients \nwith cancer. \n3. To understand the impact of interventional radiology procedures in the \noutcome of some neoplastic diseases. \nA-390 11:20 \nInterlude: Origins and development of radiology in Mexico  \nM.E. Stoopen-Rometti; Mexico/MX (mstoopen@clinicalomas.com.mx) \nMexican radiology started in 1896, just a few months after the discovery of x-\nrays. During the last few decades, as well as in other countries, there has been \na great development both in public and private sectors, which will be described \nin this interlude.  \nLearning Objectives:\n1. To learn about the history of radiology in Mexico. \n2. To learn about the development of radiology in Mexico. \n3. To learn about the present and future of radiology in Mexico. \nA-391 11:25 \nModern issues in oncologic ultrasound  \nJ. Tanus-Hajj; Mexico/MX (jtanus59@hotmail.com) \nAdvances in ultrasound (US) technolog y allow confident characterisation of \nmasses. These include harmonic imaging, compound imaging, power Doppler, \nfaster frame rates, higher resolution transducers, three-dimensional (3D) US, \nUS contrast agents and, more recently, elastography and fusion imaging. High-\nfrequency transducers provide superb spatial and soft-tissue resolution, \npermitting substantially improved differentiation of subtle lesion, margin \nresolution, and lesion conspicuity in the background of normal tissue. \nElastography features such as size ratios, shape, homogeneity, and maximum \nlesion stiffness complement conventional US in the analysis of lesions. \nUltrasound contrast agents have overcome some of the limitations of Doppler \nultrasound techniques with demonstration of irregular branching central or \npenetrating vascularity within a solid mass raising suspicion of malignant \nneovascularity (neoangiogenesis). Ultrasound contrast agents can provide \nimportant information in the assessment of lesions to be treated by \nlocoregional therapies, which include ablation (feeding vessels), trans-arterial \nchemo/radio-embolisation, detecting viable tumour persistence following this \ntreatment; facilitation of needle positioning in cases of poor lesion delineation, \nand assessment of local tumour progression. It facilitates needle positioning in \ncases of incomplete or poor lesion delineation on unenhanced ultrasound. US \ncontrast agents are an important key during the evaluation of the immediate \ntreatment effect of ablation and guidance for immediate re-treatment of \nresidual tumour.  \nLearning Objectives:\n1. To understand the role of ultrasound in the management of oncology \npatients. \n2. To learn how ultrasound is used in large oncology centers. \n3. To learn about the modern concepts of ultrasound in oncology patients. \nPanel discussion:  \nMexican requirements for international collaboration for  \nresearch programmes, including requirements for visiting professor \nprogrammes  \n11:45\n10:30 - 12:00 Room C  \nModern Imaging of the GI Tract  \nCC 1321  \nInflammatory bowel disease  \nModerator:  \nS.A. Taylor; London/UK \nA-392 10:30 \nA. Cross-sectional imaging protocols  \nM.A. Patak; Zurich/CH (Michael.Patak@hirslanden.ch) \nThe aim of this lecture is to give an overview of the techniques for imaging \ninflammatory bowel disease (IBD) of the small bowel and the colon with either \nultrasound (US), multidetector row computed tomography (MDCT) or with \nmagnetic resonance imaging (MRI) and compare the different modalities for its \nstrength and weakness. Optimal imaging of the bowel begins with the \npreparation phase. The small bowel has to be distended for a concise \nexamination. This is mainly done orally, which is named enterography. A \nsolution of 2.5% mannitol seems to be the one preparation technique mostly \nused for small bowel distension. Another technique is the enteroclysis, \napplication of contrast after intubation of the small bowel. The comparative \nadvatages and disatvantages of the two preparation methods will be \ndiscussed. This intraluminal contrast gives a neutral contrast in CT and a \nbiphasic signal in MR. The colon can be prepared in a fashion similar to \ncolonoscopy meaning total cleansing. Another possibility is the so called fecal \ntagging whereas the stool will be contrasted with an additive to standardised \nfood. Therefore no cleansing is needed for preparation. Imaging parameters \nwill be discussed for MR and CT. The aim of imaging for the bowel should be \nto establish the following: 1) presence, severity, and extent of disease; 2) \nactivity of the disease and 3) extra-inte stinal complications. US, MR and MDCT \nhave proven to be a good tool to evaluate the extent, the activity of the disease \nand the presence of extraluminal complications. Pros and cons will be \ndiscussed when to use which technique.  \nLearning Objectives:\n1. To understand state-of-the-art MRI, CT and US protocols for imaging IBD. \n2. To appreciate the comparative advantages and disadvantages of \nenterography and enteroclysis protocols. \n3. To learn about protocol modifications when evaluating the colon. \nA-393 10:50 \nB. Small bowel disease  \nJ. Stoker; Amsterdam/NL (j.stoker@amc.uva.nl) \nClassification of small bowel Crohn's disease is helpful for assessing disease \nactivity and treatment monitoring. Similar to clinically based cl assification, also \nimaging-based classification systems have been developed, of which some \nhave been externally validated. Important imaging features for determining \ndisease activity include bowel wall thickness and vascularity/enhancement; at \nMRI, also wall oedema plays a role. Stenoses, fistulas and abscesses are \nimportant sequels. For assessment and monitoring of small bowel disease \n\nA B C D E F G S88  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nactivity, ultrasound is readily availabl e and gives detailed local information but \nis limited by the restricted field of view, communication of results to clinicians \nand comparison of examinations on time. Computed tomography (CT) is fast, \nreadily available and gives a detaile d, reproducible overview, but radiation \nexposure and contrast resolution are limitations. Magnetic resonance imaging \ncombines a good, reproducible overview with high contrast resolution, dynamic \ninformation and no radiation exposure and is therefore preferable in many \nsituations, but the longer examination times than for CT, availability and costs \nare limiting factors. For the diagnosis of stenoses, fistulas and abscesses, \neither technique can be used, although the unrestricted view of CT and MRI \nfavour these techniques in many situations. In acute situations, US and CT are \nmore accessible than MRI. In that setting US can be considered, but when the \nexamination is inconclusive or the patient has clear inflammatory signs, CT is \npreferable.  \nLearning Objectives:\n1. To learn about the classifications of small bowel Crohn's disease. \n2. To become familiar with cross-sectional imaging signs of disease activity \nand complications. \n3. To understand a rational deployment of cross-sectional imaging techniques \naccording to clinical indication, highlighting the main advantages and \ndisadvantages of CT, MRI and US. \nAuthor Disclosure:\n J. Stoker: Consultant; Robarts Clinical Trials. \nA-394 11:10 \nC. Colitis  \nJ. Rimola; Barcelona/ES (jrimola@clinic.ub.es) \nEndoscopy is currently considered the reference standard for the evaluation of \ncolonic pathologies, including colitis. It allows direct visualisation of the mucosa \nand in obtaining tissue sample. However, it has major limitations including the \ninvasiveness of the technique, incomplete endoscopy and risk of perforation. \nEndoscopy cannot, therefore, help to estimate the depth of involvement of \ntransmural inflammation and extraluminal complications. By contrast, an \nevolving role for cross-sectional imaging in the evaluation of patients with \ncolitis has been increasingly recognised, especially in the setting of Crohn's \ndisease (CD), since cross-sectional imaging has been demonstrated to have a \nhigh diagnostic accuracy not only for assessing the presence and extension of \nluminal disease, but also for evaluating CD-related acute or chronic \ncomplications. Establishing the ultimate cause of colitis may sometimes be \nchallenging and histology cannot be conclusive. However, cross-sectional \nimaging may provide additional information that is useful in the workup of \ncolitis.  \nLearning Objectives:\n1. To learn about the cross-sectional imaging features of colitis. \n2. To become familiar with differentiating infectious, inflammatory, ischaemia \nand autoimmune conditions based on cross-sectional imaging criteria. \n3. To appreciate an integrated approach to the use of cross-sectional imaging \nin colonic inflammatory bowel disease. \nA-395 11:30 \nD. Interactive case discussion  \nS.A. Taylor; London/UK (csytaylor@yahoo.co.uk) \nThe use of cross-sectional imaging has been increasing in the evaluation of \ninflammatory bowel disease. Following their presentations on imaging \nprotocols and features of small bowel disease and colitis, each speaker will \npresent a case to illustrate the learning points covered in their lectures. The \nsession will be moderated by the chairman and the audience will have full \nopportunity to ask questions of all the panel.  \nAuthor Disclosure:\n S.A. Taylor: Research/Grant Support; NIHR HTA. Other; study reader for \nRobarts. \n10:30 - 12:00 Board Room B  \nRTF - Radiology Trainees Forum  \nTF 1  \nHighlighted Lectures  \nModerators:  \nV.H. Koen; Harleem/NL \nN. Pyatigorskaya; Paris/FR \nA-396 10:30 \nImaging hepatocellular carcinoma at the era of multimodality and hybrid \nimaging  \nA. Luciani, F. Legou, J. Chalaye, M. Chiaradia, F. Pigneur, M. Djabbari, \nC. Costentin, E. Itti, A. Rahmouni; Creteil/FR \nMultimodality imaging is essential in a wide variety of oncology situations. \nAnatomic imaging, whether using US, CT or MRI, is mandatory for tumour \nlocalisation. Moreover, the evaluation of treatment response mostly relies on \nsize assessment, whether uni- or bi-dimensional. With the advent of new \ntargeted bio-therapies, functional imaging has progressively been integrated in \nthe imaging strategies whether for better tumour characterisation or for optimal \nevaluation of treatment response. Hence, assessment of molecular targets by \nPET is supplemented by the recent develop ments of diffusion MRI, reflecting \ntissue architecture and cellularity, ti ssue perfusion, reflecting angiogenesis, \nand magnetisation properties of tissues. HCC is a primary liver tumour where \nthe use of multimodal anatomic, functional and metabolic imaging appears of \nparticular interest. According to EASL and AASLD recommendations, non-\ninvasive diagnosis of HCC can be performed using dynamic contrast enhanced \ncross sectional imaging. Liver MRI provide s optimal sensitivity and specificity \nfor the detection of as small as 1 cm large HCC. Recent reports have \nsuggested that the prognosis of HCC lesions could be anticipated based on the \ncombined analysis of metabolic 18 F -FDG PET CT, as well as with diffusion \nweighted imaging. The objective of this lecture will be to highlight the potential \nof combining both metabolic and multimodal cross sectional imaging in order to \nimprove the management of patients with HCC.  \nLearning Objectives:\n1. To appreciate the role of combined multimodal imaging for the management \nof patients with HCC. \n2. To better understand the role of metabolic imaging for the management of \npatients with HCC. \n3. To understand the role of multimodal functional imaging for prognosis \nassessment in HCC patients. \nA-397 11:00 \nThe (extra)ordinary night shift at the ER  \nK. Petrovic; Novi Sad/RS (smakap@sbb.rs) \nBesides the accuracy, working at the ER requires maximal shortening of the \ndiagnostics time, which has a significant influence on the patient's outcome. \nThus, it is the radiologist's duty to be familiar with the pathophysiological \nmechanism of the disorders, specific protocols, possibilities and limits of certain \nexaminations, and also to be aware of a ll possible pearls and pitfalls, to make \nthe correct diagnosis. Pathology encountered at the ER has an extremely wide \nrange and requires expertise in all imaging modalities from head to toe. The \nmore the radiologist is aware of all possible situations, the more is the \ndiagnosis accurate, and information given to  the clinician is more valuable. The \naim of this presentation is to point out the possibility of encountering different \npathological conditions in different body regions. Moreover, it is important to be \nreminded that in radiology there are different modalities, each of which has its \nown indications and limits. This lecture reviews the selected series of cases \nfrom the ER Department of Clinical Center of Vojvodina, pointing out the most \ncommon possible differential diagnosis  and possible diagnostic mistakes, \nwhich often occur due to the lack of experience.  \nLearning Objectives:\n1. To point out the in-depth knowledge and experience in all imaging modalities \nand all body regions required for a radiologist to perform a routine work at the \nER. \n2. To present a series of cases that are most and less often encountered at the \nER, discuss the possible differential diagnosis and mistakes which could \npotentially be made. \nA-398 11:30 \nDiagnosis and management of pancreatic cystic lesions  \nR.J. Méndez; Madrid/ES (ramiro.mendez@salud.madrid.org) \nPancreatic cystic lesions are frequently diagnosed in patients with clinically \nsuspected pancreatic disease, but they are also increasingly detected on \nimaging studies performed due to other abdominal processes. The prevalence \n\nA B C D E F G S89  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nof pancreatic cysts increases with patient's age. Most symptomatic cysts will be \nsurgically resected, whereas asymptomatic lesions should be managed \ndepending on the likelihood of causing harm to the patient. Cystic lesions can \nbe inflammatory or neoplastic. The incidence of pseudocysts is low without a \nhistory of pancreatitis. Some pancreatic cystic neoplasms are malignant, but \neven benign lesions can become symptomatic depending on its size and \nlocation in the pancreas. The radiologist detects most of the pancreatic cystic \nlesions and should also play an important role in the clinical decision-making \nprocess. Cyst size, morphology, calcific ations, contrast enhancement, location \nin the pancreas, relation with pancreatic ducts, patient's age and gender are \nimportant data to classify the lesion. A specific radiological diagnosis is not \npossible in every patient, but in many cases this information is enough to \ndecide on a conservative approach with imaging follow-up. If a more \naggressive lesion is a concern, then endoscopic ultrasound and fluid analysis \ncan help to better characterise some pancreatic cystic lesions. Cyst puncture is \nonly recommended if fluid analysis results will modify the patient's \nmanagement. Patient's age, status and preferences should also be taken into \naccount. When follow-up is recommended, the preferred imaging technique \nand interval should be indicated.  \nLearning Objectives:\n1. To learn about the prevalence of pancreatic cystic lesions in the general \npopulation and how frequently they are detected on imaging studies. \n2. To understand the different types of pancreatic cystic lesions, with emphasis \non the more frequent aetiologies. \n3. To become familiar with the radiological signs helping to classify the \npancreatic cysts. \n4. To learn about the consensus guidelines for the management of pancreatic \ncystic lesions. \n10:30 - 12:00 Room N/O  \nProfessional Challenges Session  \nPC 13  \nDoing good not harm - understanding \naudit and its role in reducing patient dose  \nA-399 10:30 \nChairman's introduction  \nP. Cavanagh; Taunton/UK (peter.cavanagh@gmail.com)\nThe Chair will set the scene for the need for effective radiation protection in \nclinical radiology and highlight the role of clinical audit as a tool in achieving \nthis.\nSession Objectives: \n1. To appreciate the case for improved radiation protection in diagnostic \nradiology. \n2. To understand the principles of clinical audit. \n3. To learn how clinical audit can be an effective tool in radiation dose \nreduction. \n4. To recognise the relative merits of both internal and external Audit. \nA-400 10:35 \nInternal audit in the UK  \nS. Barter; Cambridge/UK (suebarter@btinternet.com) \nClinical audit is defined as a professionally led method of improving patient \ncare through the systematic examination of systems, processes and outcomes \nagainst chosen and agreed standards. It can readily be carried out by \nindividuals, groups or whole departments. If properly conducted, clinical audit \ncan be an effective way of examining what we do to provide reassurance on \nperformance, and to improve patient care. The Clinical Radiology Audit \nCommittee (CRAC) of the Royal College of Radiologists (RCR) co-ordinates \nnational radiology audit activity. It promotes and facilitates audit through \nnominated audit leads in each hospital, who act as a link between the RCR \nand their department. At least one national audit is carried out annually, with \ndata collected via electronic submission and the anonymised results presented \nat an annual Audit Forum. Individual de partmental results are analysed using \nstatistical process control (SPC) methodology. This enables identification of \ndepartments underperforming against the national mean, and recommending \ncorrective action, by redesigning the process being audited, or by identifying \nand eliminating specific root causes locally. The Committee has developed a \nweb-based tool for facilitating local audit, \"AuditLive\", a fully searchable \ncollection of templates which can be downloaded and adapted. Fellows are \nalso able to submit their own templates for publication hence sharing best \npractice. Trainees are encouraged to participate in audit through Audit Poster \ncompetitions at National Radiology Scientific Meetings. Our experience leads \nus to believe that audit succeeds when relevant, locally owned and properly \nstructured, and multi-professional, and the RCR model encourages this.  \nLearning Objectives:\n1. To comprehend the role of clinical audit in radiology practice. \n2. To understand how to facilitate clinical audit locally and nationally. \n3. To become familiar with some of the systems developed in the UK by the \nRoyal College of Radiologists. \nAuthor Disclosure:\n S. Barter: Board Member; Chair Case Collection Committee European Board \nof Radiology, Member of Scientific Board European Board of Radiology. \nEmployee; Cambridge University Hospitals Foundation NHS Trust. \nA-401 10:58 \nModels of external audit in the Netherlands  \nS. Geers-van Gemeren; Utrecht/NL \nIn the Netherlands clinical audit is legally obligatory for healthcare professions \nin order to be able to practise since 2 010. Clinical audit is a tool designed to \nimprove the quality of patient care, experience and outcome through formal \nreview of systems, pathways and outcome of care against defined standards, \nand the implementation of change based on the results. The quality of the \nprovision of care by professionals is assessed by peers. In the fields of \nRadiology, Nuclear Medicine and Radiotherapy, different models of clinical \naudit are used. For radiotherapy a multidisciplinary audit has been used since \n2003. For Nuclear medicine a multidisciplinary audit has been implemented \nsince 2013. For radiology the clinical  audit for radiologists and for \nradiographers are separate. Implementation of the multidisciplinary audits \nneeds requirements and adjustments of the audit system. This process is \ncomplex and needs approval of the members of all involved societies. To \nsupport the clinical audit a web based tool ADAS (General Digital Audit \nSystem) is used. The development of professional standards is a prerequisite \nto start clinical audit. The use of ADAS in multidisciplinary audits is a \nrequirement to be able to audit different professions and focus on the content \nand the quality of their contribution to patient care. Clinical audit is a good tool \nto improve the quality of patient care. Important are the professional standards, \nthe culture of learning and willing to improve by the professionals. “Every \ndefect is a treasure.” \nLearning Objectives:\n1. To learn about the different Dutch m odels of external clinical audit. \n2. To comprehend the importance of professional standards, the culture of \nlearning and willingness to improve. \n3. To become familiar with the use of a digital audit system to support \nmultidisciplinary clinical audit. \nA-402 11:21 \nExternal regulatory audit in Finland  \nR. Seuri; Helsinki/FI (raija.seuri@hus.fi) \nDirective 97/43/Euratom states that the clinical audit of medical imaging should \nbe carried out in accordance with national procedures. The Finnish solution \nhas been regulatory external audits eve ry five years by radiological \nprofessionals with special training fo r audits. All radiological units have so far \nbeen audited at least twice, and the third time is performed on site in the unit. \nAlthough the purpose is to audit the pr ocess of radiological practises compared \nto \"good practise\", special focuses are recommended by the Finnish advisory \ncommittee for clinical audit, set by the Na tional Institute for Health and Welfare. \nAt the beginning focus was on the organisation and documentation of the \nstructure and processes of imaging practise like justification, optimisation and \nquality control, but also encouragement and guidance to self-assessment. \nLater special focus has been on paediatric imaging and CT, and the third cycle \nwill target deeper to CT practises. The auditing group includes at least a \nradiologist and a radiographer to audit a small unit, and a medical physicist if \nthe unit has high-dose modalities like CT. During the audit the auditors work for \nan independent organisation. Multi-professionality gives both insight and the \npossibility to contact all professionals in imaging practise. The focus of clinical \naudit is on quality improvement; it is a way to both give and get feed-back and \neducation. It is not control or inspection, but encouragement and guidance to \nself evaluation and implementation of good practises.  \nLearning Objectives:\n1. To comprehend the supportive role of clinical audit. \n2. To understand the different roles of clinical audit and technical quality \ncontrol. \n3. To become familiar with the Finnish clinical audit system. \nAuthor Disclosure:\n R. Seuri: Consultant; STUK - Radiation and Nuclear Safety Authority, \nFinland. Other; Auditor: Labquality, Finland. \nPanel discussion:  \nHow can we use audit more effectively in reducing \npatient dose?  \n11:44\n\nA B C D E F G S90  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n12:15 - 12:45 Room A  \nPlenary Session  \nHL 3  \nSamuil A. Reinberg Honorary Lecture  \nPresiding:  \nV.E. Sinitsyn; Moscow/RU \nA-403 12:15 \nThe tempestuous genesis of MRI: credit and discredit  \nM.A. Meyers; East Setauket, NY/US (jimenez1234@optonline.net) \nWe often think of the scientific researcher as detached, objective, and \ndispassionate, nobly labouring withou t any expectation of reward. Nothing \ncould be further from the truth. Sci entists are as subject to ambition, \ncompetitiveness, envy and even guile as any person. Lifting the veil on \nscientific discovery reveals to us the hu man dramas that underlie not only the \ncoveting of recognition, but also great co nflicts over priority and credit. \nNowhere are the stakes higher than for that pinnacle of scientific honour: the \nNobel Prize. MRI has had a notably tempestuous genesis - a cogent episode \nthat has much to teach us. It involved an explosive clash of personalities; \ndeceit and rampant self-interest; challenges to the basic concept of scientific \nbehavior; legal suits and validation by the United States Supreme Court; and \ndeclamations of denunciation in the international press. It persisted as a 30-\nyear battle - a prize fight, a blood feud - between two protagonists: one whose \nseminal contribution established the biologic basis of MRI, and the other whose \nflash of insight served as a cornerstone of diagnostic imaging. One was \nawarded the Nobel Prize in medicine in 2010. The other was excluded. Why?  \nLearning Objectives:\n1. To understand the human elements in the process of discovery. \n2. To understand the factors that determine the attribution of priority and credit. \n3. To understand the courage to think on entirely new lines with innovative \ncombinations of insights from different fields. \n4. To understand the challenge of being in a race with another researcher. \n5. To understand the power of entrenched dogma. \n6. To understand the temptation of scientific misconduct. \n12:30 - 13:30 Room E2  \nThe Beauty of Basic Knowledge: Skeletal Radiology  \nMC 26D  \nMetabolic, endocrine and marrow disease  \nModerator:  \nV.N. Cassar-Pullicino; Oswestry/UK \nA-404 12:30 \nMetabolic, endocrine and marrow disease  \nB. Vande Berg, A. Larbi, V. Perlepe, J. Malghem, F.E. Lecouvet; Brussels/BE\n(bruno.vandeberg@uclouvain.be) \n1. Metabolic disorders of the skeleton involve the mineralised components of \nthe skeleton. They affect all bone components histologically, but involvement \npatterns may vary depending on the age of the patient (growing versus adult \nskeleton) as well as the type of bone (cortical versus trabecular bone). They \ncan be depicted on radiographs and CT images, but remain occult on MR \nimages because the bone marrow is spared in the vast majority of these \ndisorders. MR imaging can help in the assessment of local complication such \nas fractures. 2. Metabolic disorders of the bone marrow can affect either red \n(anemia…) or yellow marrow as well as the balance between these 2 marrow \ntypes in the body. Medical imaging plays a limited role in the assessment of \nthese disorders, but marrow changes associated with these metabolic \nconditions must be recognised to avoid confusion with neoplastic conditions.  \nLearning Objectives:\n1. To appreciate the musculoskeletal manifestations of systemic disorders and \ntheir underlying pathomechanisms. \n2. To understand the pathological processes involved in these imaging \nabnormalities. \n3. To appreciate the strengths and weaknesses of imaging modalities in \nassessing these disorders. \n12:30 - 13:30 Room F1  \nThe Beauty of Basic Knowledge: Interventional Radiology  \nMC 25D  \nTumour ablation: a primer  \nModerator:  \nM. Bezzi; Rome/IT \nA-405 12:30 \nTumour ablation: a primer  \nT.K. Helmberger; Munich/DE (Thomas.Helmberger@klinikum-muenchen.de) \nIn primary and secondary malignant tumours of solid organs, in most of the \ncases surgical resection is considered the curative treatment. However, this is \npossible only in about 20% of the cases with tumour-dependent recurrence \nrates of 60% and even more. The main components for adjuvant, neo-adjuvant \nand finally palliative therapy are the permanently growing number of chemo- \nand antibody therapies. Nevertheless, in many cases these therapies provide \nno definitive or long-lasting success, necessitating multimodality treatment \nconcepts. In the meantime, local ablative techniques represent the main \ncomponents of these concepts. Three main minimally invasive tumour-ablative \ntechniques can be differentiated: chemo-ablation (percutaneous alcohol \ninjection, transarterial chemo-embolisation, chemotherapy, chemo-perfusion), \nthermo-ablation (radiofrequency-, microwave-, laser-ablation, high-intensified \nfocused ultrasound, cryo-ablation) and radio-ablation (radio-embolisation, \ninterstitial brachytherapy, percutaneous stereotactic radiation). These ablation \ntechniques differ significantly among each other with respect to their mode of \naction and indications; nevertheless, their benefit is high tolerance and at the \nsame time high therapeutic efficacy, which can easily be combined with other \ntreatment modalities. The different minimally invasive techniques will be \ndiscussed together with specific short- and long-term results and \ncomplications.  \nLearning Objectives:\n1. To understand the indications for tumour ablation. \n2. To learn about the technique and devices for image-guided ablation. \n3. To learn about results, complications and follow-up strategies. \n14:00 - 15:30 Room A  \nInteractive Teaching Session  \nE³ 1420  \nCommon and uncommon errors in plain \nfilm and CT imaging of the chest: how to \nimprove your performance  \nA-406 \n14:00 \nCommon and uncommon errors in plain film and CT imaging of the chest: \nhow to improve your performance  \nD. Tack1, N. Howarth2; 1Baudour/BE, 2Chêne-Bougeries/CH\nMissed lung lesions are one of the most frequent causes of malpractice issues. \nChest radiography plays an important role in the detection and management of \npatients with lung cancer, chronic airw ays disease, pneumonia and interstitial \nlung disease. Among all diagnostic tests, ch est radiography is essential for \nconfirming or excluding the diagnosis of most chest diseases. However, \nnumerous lesions of a wide variety of disease processes affecting the thorax \nmay be missed on a chest radiograph. The chest radiograph will also help \nnarrow a differential diagnosis, help to  direct additional diagnostic measures, \nand serve during follow-up. The diagnostic usefulness of the radiograph will be \nmaximised by the integration of the radiological findings with the clinical \nfeatures of the individual patient. CT ha s a tremendous spatial resolution that \nhelps detect lesions in the chest and has proven to be more sensitive and \nspecific than chest radiographs. However, missing lesions or misinterpreting \nlesions in CT of the chest is not uncommon. In this session, we will provide \ninteractive cases of chest examinations (radiographs and CT) in which lesions \nhave been missed and or misinterpreted, with a special focus on how \ncorrelation with MDCT of missed lung lesions can help improve interpretation \nof plain chest radiographs.  \n\nA B C D E F G S91  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To learn about the common reasons for errors in the interpretation of plain \nfilm and CT imaging. \n2. To understand how a side-by-side comparison of the chest x-ray and MDCT \nwith missed lesions can help reduce the busy radiologist's error rate. \n3. To learn about the skills required for accurate interpretation of plain film and \nCT imaging of the chest. \n14:00 - 15:30 Room B  \nNew Horizons Session  \nNH 14  \nImaging in precision medicine  \nA-407 14:00 \nChairman's introduction  \nH. Hricak; New York, NY/US (hricakh@mskcc.org) \nThis session will explore the value of imaging for facilitating precision medicine, \nin which molecular data (including genomics, proteomics and metabolomics) is \nused to classify patients into subpopulations and tailor treatments to the \nspecific molecular characteristics of thei r diseases. Imaging already plays a \nlimited role in precision medicine, primarily through the use of molecular \nimaging techniques (e.g. PET/CT, MRI/PET and hyperpolarised MRI) and \ntheranostics (the combination of an imaging  agent with a therapeutic entity). In \nthe near future, the role of imaging in precision medicine will increase at a \ngradually accelerating pace through the development of new molecular \nimaging probes and theranostic agents and through progress in radiogenomics \n(the correlation of radiologic findings with genomic features). This session will \ndiscuss recent findings and methodologies in radiogenomics as well as the use \nof nanotechnology for designing novel molecular imaging probes and \ntheranostics. In addition, as theranost ics is often considered the essence of \nprecision medicine, the session will provide an in-depth look at current and \nemerging theranostic strategies and their special benefits for treatment \nselection, assessment of dose distribution of targeted therapies, and treatment \nfollow-up.  \nSession Objectives: \n1. To understand the importance of imaging in precision medicine. \n2. To learn about the emerging field of radiogenomics. \n3. To appreciate the value of nanotechnology for molecular imaging and \ntheranostics. \nA-408 14:05 \nRadiogenomics and personalised (precision) medicine  \nG.P. Krestin; Rotterdam/NL (g.p.krestin@erasmusmc.nl) \n\"Precision medicine\" as well as related notions, such as personalised \nmedicine, or stratification medicine, all revolve around the idea that the \nconsideration of individual characteristics - molecular and otherwise - can \nimprove medical research and practice. Precision medicine is a multi-faceted \napproach to medicine that integrates molecular and clinical research with \npatient data and outcomes. Individual assessment of the location and extent of \nan alteration is and always has been the basis of medical imaging, whether the \n'alteration' is a disease, a malformation, or an injury. As such, medical imaging \nintrinsically enables \"precision medicine\".  The addition of genomic data in the \nlast twenty years allows new correlations to be made between cellular \ngenomics and tissue-scale imaging. Structural and functional imaging and the \nautomated analysis of large amounts of image data have only recently reached \na stage where they can be used on a large scale and in a population setting. \nIdentifying common genetic variants that contribute to explain variance in \nimaging phenotypes by a systematic analysis of the genome is based on \ngenome-wide association studies (GWAS). The power of GWA analyses has \nbeen recently demonstrated with the identification of susceptibility genes \ninvolved in a range of imaging phenotypes like coronary artery calcifications, \nintracranial volume, or size of the hippocampus. These developments highlight \nnew etiological pathways and are expected to improve the understanding of \nthe molecular basis of some diseases. Correlation between genotype and \nimaging phenotypes may be relevant for further characterising the \ndevelopment of disease states.  \nLearning Objectives:\n1. To understand new concepts of precision medicine. \n2. To learn about the potential correlation between genomics and imaging \nphenotypes. \n3. To appreciate the future role of imaging in precision medicine. \nAuthor Disclosure:\n G.P. Krestin: Advisory Board; Technion University, LMU,. Consultant; GEHC \nEurope. Grant Recipient; Siemens, GEHC, Bayer HC, Philips HC, Bracco SA. \nA-409 14:28 \nUse of nanotechnology, imaging and therapy  \nT. Lammers; Aachen/DE (tlammers@ukaachen.de) \nAdvances in nanotechnology and chemical engineering have led to the \ndevelopment of a significant number of novel materials for diagnosis and \ntherapy. Many different diagnostic and therapeutic nano- and micro-materials \nhave been designed and evaluated over the years, including, e.g. gadolinium-\ncontaining dendrimers, USPIO nanoparticles and microbubbles for functional \nand molecular imaging, and drug-loaded liposomes, polymers and micelles for \ntemporally and spatially controlled drug delivery to tumors and to sites of \ninflammation. In the literature, such advanced nano- and micromaterials are \ngenerally claimed to be highly useful and broadly applicable. A critical \nreflection on their specific capabilities, however, as well as on their \npharmacokinetic properties, biodegradability and toxicity is often lacking. In the \npresent lecture, I will briefly introduce the rationale for using diagnostic and \ntherapeutic nanomaterials. I will highlight several clinically relevant examples in \nwhich nano- and micromaterials hold po tential for improving disease diagnosis \nand detail how combining diagnostic and therapeutic properties within a single \n'nanomedicine' formulation can be used to individualise and improve (chemo-) \ntherapeutic treatments.  \nLearning Objectives:\n1. To learn about the design and construction of nanoparticles for use in \nimaging and therapy. \n2. To appreciate both the advantages and limitations of using nanoparticles as \nagents for both imaging and therapy. \n3. To learn how nanotechnology enables multimodality imaging and \ntherapeutic agents. \nA-410 14:51 \nTheranostics  \nW. Weber; New York, NY/US \nPrecision medicine requires diagnostic tests that predict the effectiveness of \nspecific therapeutic interventions for indivi dual patients. This close interaction \nbetween therapeutics and diagnostics is expressed in the term \"theranostics\". \nA frequently used example for a theranostic is the staining of tumours for \nHER2 expression prior to therapy with HER2 antibodies, such as trastuzumab \nor pertuzumab. Theranostic has also been practised since many years in \nnuclear medicine by using radioiodine scans to select patients for treatment \nwith iodine-131. A more recent example is the selection of patient for peptide \nreceptor-targeted radiotherapy (PRRT) by somatostatin receptor imaging. \nImaging is highly attractive for theranostics, because it allows investigators to \nstudy the spatial and temporal heterogeneity of target expression, whereas in \nvitro assays generally analyse a small part of the tumour at one point in time. \nSeveral molecular imaging probes, such \n89Zr-trastuzumab or folate receptor \ntargeting ligands, are in clinical development as in vivo companion diagnostics. \nImaging companion diagnostics can also be used to assess tissue \npharmacokinetics and thereby help to determine the optimal dose and dose \nschedule of therapeutic agents. They can also identify unexpected interactions \nbetween two therapeutic agents. For example, studies with \n11C-docetaxel have \nshown that bevacizumab can markedly decrease the intratumoral delivery of \ndocetaxel. Finally, imaging-based companion diagnostics can assess target \ninhibition, as demonstrated by the inhibi tion of uptake of the androgen receptor \nligand 18F-FDHT in metastatic prostate cancer treated with anti-androgens. \nImaging-based companion diagnostics are therefore expected to play an \nimportant role in establishing precision medicine.  \nLearning Objectives:\n1. To become familiar with current and emerging theranostic strategies and \ntechnologies. \n2. To understand the value of theranostics for assessing dose distribution and \nthe efficacy of targeted therapy. \n3. To understand the key benefits of theranostics for treatment selection and \nfollow-up. \nAuthor Disclosure:\n W. Weber: Advisory Board; Endocyte, MSD. Grant Recipient; Bayer, Philips. \nPanel discussion:  \nImaging in precision medicine: extracting simplicity  \nfrom complexity  \n15:14\n\nA B C D E F G S92  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n14:00 - 15:30 Room C  \nModern Imaging of the GI Tract  \nCC 1421  \nRectal cancer  \nModerator:  \nL.C.O. Blomqvist; Stockholm/SE \nA-411 14:00 \nA. Imaging protocols  \nS. Gourtsoyianni; London/UK (sgty76@gmail.com) \nERUS technique as well as the state-of-the-art MR imaging protocols tailored \naccording to the presenting rectal tumor site, allowing trained radiologists to \nobtain all necessary information for appropriate treatment decision-making, will \nbe described. Normal cross-sectional appearances as well as morphological \nand signal changes encountered in pelvic structures/tissues that may be \ninvolved in primary rectal cancer will be illustrated. The influence of imaging \nfindings on initial therapeutic approach and potential limitations of different \nimaging techniques will be discussed.  \nLearning Objectives:\n1. To become familiar with state-of-the-art MRI and US protocols for rectal \ncancer staging. \n2. To understand the normal appearances of the rectum and perirectal tissues \non cross-sectional imaging. \n3. To understand the advantages and disadvantages of imaging techniques in \nevaluating the rectum. \nA-412 14:20 \nB. How to stage lymph nodes in rectal cancer  \nG. Brown; Sutton/UK (gina.brown@rmh.nhs.uk) \nThe staging and categorisation of malignant lymph nodes in patients with rectal \ncancer is a topical issue and has resulted in some degree of confusion. Much \nenthusiasm has been expended in determining whether mesorectal nodes are, \nor are not, involved in the primary disease process, as there is a perception \nthat nodal disease is an important determinant of local recurrence. This \nincorrectly perceived association of nodal status and a high risk of pelvic \nrecurrence have propagated the concept that this should be the primary \nindication for neoadjuvant therapy regardl ess of whether TME surgery is to be \nperformed. Furthermore, misinterpretation of involved local nodes results in \nover-treatment of patients, if firstly in volved nodes alone are considered as a \npoor prognostic factor, and secondly the optimal treatment of involved nodes is \npelvic radiotherapy plus a non-systemically acting but radiosensitising dose of \nchemotherapy within chemoradiotherapy (CRT) schedules. In this lecture, the \nevidence for risk factors associated with nodal disease and validated risk \nfactors for local recurrence will be reviewed. The evidence for both the optimal \ntechniques and objective criteria for assessing lymph nodes with magnetic \nresonance imaging (MRI) will be presented.  \nLearning Objectives:\n1. To learn about the importance of lymph node staging in rectal cancer. \n2. To become familiar with an approach to assessing lymph nodes and be \naware of pitfalls. \n3. To appreciate the influence of nodal status on treatment outcomes. \nA-413 14:40 \nC. Assessment after treatment  \nR.G.H. Beets-Tan; Maastricht/NL (r.beets.tan@mumc.nl) \nThe standard treatment for advanced rectal cancer is preoperative \nchemoradiotherapy (CRT) followed by standard resection of the rectum and \nmesorectum. Neoadjuvant CRT allows downsizing and downstaging of the \ntumour, leading to improved resectability and local control. While the role of \nMRI in rectal cancer treatment is recognised and MRI is recommended as part \nof the standard staging workup, its role for restaging after preoperative \ntreatment is more controversial. This lecture will provide an understanding of \nwhether and how MRI can assess treatment response in rectal cancer and how \nit may impact treatment decision. The attendees will learn about the difficulties \nin image interpretation and learn about potential new imaging techniques to \nimprove its performance.  \nLearning Objectives:\n1. To understand the role of imaging in treatment response assessment of \nrectal cancer. \n2. To learn about imaging features which identify viable disease after chemo-\nradiation. \n3. To appreciate the role of imaging in the modern management of patients \nwith rectal cancer. \nA-414 15:00 \nD. Interactive case discussion  \nL.C.O. Blomqvist; Stockholm/SE \n14:00 - 15:30 Room D  \nChest  \nRC 1404  \nPulmonary infections: the old and the new  \nModerator:  \nN. Sverzellati; Parma/IT \nA-415 14:00 \nA. Mycobacterial infections  \nC. Beigelman; Lausanne/CH \nPrimary TB typically presents with consolidation in the middle and lower lobes, \nand necrotic lymphadenopathy. Fibrosis, tuberculomas and calcified nodes \nmay result as sequelae. Cavitation and tree-in-bud appearance involving the \napical and posterior segments of the upper lobes and the superior segments of \nthe lower lobes are the hallmarks of reactivation TB is typically seen in \nimmunocompetent patients. In immunocompromised patients, primary TB \nfindings are more commonly observed, as miliary or disseminated disease or \natypical manifestations in case of severe immunosuppression. Pleural effusion \nand tracheobronchial involvement may be observed. The \"classical\" \nappearance of non-TB mycobacteria (N\nTM), less common and more indolent \nthan TB, typically affects males more than 50 years old with pre-existing \npulmonary disease or underlying immunologic disorder. Despite a great \noverlap in the radiologic appearances of both infections, the presence of \ncavities on sites other than the upper lobes should suggest an N\nTM infection. \nThe \"nonclassical\" form related to MAC infection that predominantly affects \nelderly women with no pre-existing pulmonary disease mainly consists in mild \nbronchiectasis and centrilobular nodules predominantly located in the lingula \nand middle lobe. A high rate of lymphadenopathy and disseminated disease \nare seen in immunocompromised patients. The radiologist has to ensure the \ndiagnosis of active TB and mention scarri ng before starting specific treatments; \nto suggest N\nTM infections, immune reconstitution inflammatory syndrome with \nparadoxical worsening in HAART treated HIV-infected patients as multi-drug \nresistant TB; to appreciate the extent of disease and follow-up; to diagnose the \ncomplications; to propose MRI or PET scans in some situations.  \nLearning Objectives:\n1. To appreciate the imaging features of primary and post-primary infections in \nTB. \n2. To learn about the similarities and differences between TB and non-TB \nmycobacterial infections. \n3. To understand the radiologist's role in diagnosis. \nA-416 14:30 \nB. Infectious disease in immuno-compromised patients  \nC. Heussel; Heidelberg/DE \nThe appropriate investigational technique, frequently targeted differential \ndiagnosis, and the special needs of immunocompromised patients need to be \nunderstood by the referring physician as well as by the radiologist. Thus, an \nintensive interdisciplinary co-operation on a patient basis, as well as on a \ndepartment basis is essential. Early detection of a focus is the major goal in \nfebrile neutropaenic patients. As pneumonia is the most common focus, chest \nimaging is a special radiological task. T he sensitivity of chest x-ray, especially \nin the supine position, is known to be low. Therefore, the very sensitive thin-\nsection multislice-CT became the gold standard in neutropenic hosts and might \nbe cost-effective in comparison to antibiotic treatment. The infiltrate needs to \nbe localised, so that this information can be used as guidance for invasive \nprocedures for further microbiological workup. Furthermore, the radiological \ncharacterisation of infiltrates gives a firs t and rapid hint to differentiate between \ndifferent sorts of infectious (e.g. typical ba cterial, atypical bacterial, fungal) and \nnon-infectious aetiologies. Follow-up investigations need careful interpretation \naccording to disease, recovery, and concomitant treatment. Due to a high \nincidence of fungal infiltrates, interpretati on of the follow-up of an infiltrate must \nuse further parameters besides the lesion size. Besides the lungs, also other \norgans systems such as brain, liver and paranasal sinuses need attention and \nare to be imaged with the appropriate technique.  \nLearning Objectives:\n1. To appreciate the various types of immuno-deficiencies and their related \ninfections. \n2. To become familiar with the role of the radiologist in immuno-compromised \npatients. \n3. To learn how to follow pulmonary infections in immuno-compromised \npatients. \n\nA B C D E F G S93  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nAuthor Disclosure:\n C. Heussel: Consultant; Schering-Plough, Pfizer, Basilea, Boehringer \nIngelheim, Novartis, Roche, Astellas, Gilead, MSD, Lilly, Intermune, Fresenius. \nPatent Holder; Methods and Device For Representing the Microstructure of the \nLungs. IPC8 Class: AA61B5055 FI, PAN: 20080208038, Inventors: W. \nSchreiber, U. Wolf, A.W. Scholz, C.P. Heussel. Research/Grant Support; \nSiemens, Pfizer, MeVis. Shareholder; Stada, GSK. Speaker; Gilead, Essex, \nSchering-Plough, AstraZeneca, Lilly, Roche, MSD, Pfizer, Bracco, MEDA \nPharma, Intermune, Chiesi, Siemens, Covidien, Pierre Fabre, Boehringer \nIngelheim, Grifols, Novartis. \nA-417 15:00 \nC. Emerging infections  \nT. Franquet; Barcelona/ES (tfranquet@santpau.cat) \nDespite advances in diagnosis and treatment, new pulmonary infections have \nbeen diagnosed. Streptococcus pneumoniae  remains the main aetiological \nagent in outpatients with community-acquired pneumonia (CAP). Elderly \npatients or those with toxic habits and various comorbidities favour the \ndevelopment of severe CAP. In addition, the development of nucleic acid \namplification techniques has emphasised the role of concomitant bacterial and \nviral pneumonia in the outcome of CAP in elderly patients. Healthcare-\nassociated pneumonia has been recently defined as a different infectious \ncondition by the American Thoracic Society/Infectious Diseases Society of \nAmerica (ATS/IDSA). The main concern of this new disease is the risk of \nhaving an infection due to multidrug-resistant pathogens. With the advent of \nHAART and increased long-term survival of HIV-positive patients, the range of \npulmonary manifestations has also evol ved. In patients with haematological \nmalignancies or after HSC transplant, Aspergillus is a common infection. \nActually, Aspergillus spp. isolation from LRT samples in COPD may indicate an \nincreased diagnosis possibility of IPA. New emerging viruses such as Human \nmetapneumovirus (hMPV), SARS-associated coronavirus, and Avian influenza \ncaused by the H5N1 virus have been diagnosed. In 2009, an outbreak of a \nnovel swine-origin influenza A (H1N1) virus was reported. The clinical \ndiagnosis of new pulmonary infections as well as the presence of concomitant \nbacterial and viral infections has been significantly enhanced by improved \nlaboratory methods. A systematic approach to the radiological evaluation of \nlung infections is essential and includes not only chest imaging pattern \nrecognition, but also integration of available demographic, clinical and \nlaboratory information.  \nLearning Objectives:\n1. To learn more about emerging infections. \n2. To become familiar with radiological patterns and conditions which suggest \nviral infections. \n3. To learn how to improve diagnostic accuracy. \n14:00 - 15:30 Board Room B  \nPaediatric  \nRC 1412  \nNormal variants in paediatric imaging: not \nto be confused with disease  \nModerator:  \nM. Raissaki; Iraklion/GR \nA-418 14:00 \nA. Brain  \nA. Rossi; Genoa/IT (andrearossi@ospedale-gaslini.ge.it) \nThe paediatric central nervous system is a complex structure undergoing rapid \ndevelopment. As such, there is a rapid, continuous modification of what is \n\"normal\" in relation to age and the stage of development. Knowledge of the \nnormal patterns of brain development in the clinically relevant ages from 0 to \n18 years is necessary to interpret neuroimaging findings correctly. Knowledge \nof embryology and normal variants is also greatly helpful. MR imaging \nequipment and parameters need to be adjusted and optimised for paediatric \nstudies. Pitfalls often occur from the misunderstanding of normal conditions \nthat are perceived as abnormal based on a comparison with the appearance of \nthe normal brain in adults. This inclu des, for instance, the evaluation of the \nbrain in the first 2-3 years of life during the course of the process of \nmyelination. A summary of the most frequent conditions that may lead to \nmisinterpretation of findings will be provided.  \nLearning Objectives:\n1. To learn about normal variants in the neonatal and child's brain. \n2. To understand the typical imaging characteristics of normal variants that \nshould suffice for correct interpretation. \n3. To become familiar with the differentiation between normal variants and \ndisease. \nA-419 14:30 \nB. Chest and abdomen  \nS.G.F. Robben; Maastricht/NL (s.robben@mumc.nl) \nA wide spectrum of anomalies of thoracic and abdominal organs may be \nencountered on radiologic evaluation. These anatomic variants and \ndevelopmental anomalies can all pose a diagnostic challenge to the radiologist. \nFamiliarity with these anomalies, the im aging techniques available for their \nstudy, and their variable imaging mani festations is necessary for differentiating \nthem from pathology. A basic understanding of the embryologic development \nand normal anatomy of thoracic and abdominal organs and vessels is also \nessential for identifying these anomalies. This review explores the wide \nvariability in appearance of the normal thoracic and abdominal organs during \nimaging, stressing a thorough understanding of normal anatomy to recognise \nnormal variants.  \nLearning Objectives:\n1. To learn about normal variants in the neonatal and paediatric chest and \nabdomen. \n2. To become familiar with the imaging appearances of common normal \nvariants. \n3. To understand how to differentiate between normal variants and disease. \nA-420 15:00 \nC. Musculoskeletal  \nF. Saez; Barakaldo/ES (fersaez@yahoo.com) \nThe skeleton of a child is a developing system with a variety of changing \nnormal appearances. Imaging studies, especially plain films, are requested for \nmany clinical reasons, and the radiologist is in the position to determine if an \nimage is a normal finding or we are dealing with a lesion. The way the physis \nand epiphysis grow, ossify, and fuse constitutes a great source of \nphysiologically bizarre appearances, which the radiologist must be familiar \nwith. This talk will concentrate on the plain film diagnosis of some of the most \ncommon musculoskeletal variants. Other imaging modalities will also be shown \nwhen appropriate for the case. Irregularities, asymmetries, partial fusions, \nhypo- or hyper-dense bone areas, accessory bones, prominent normal \nstructures, external artifacts, and potential fracture lines are the most often \nencountered pseudolesions. A defective radiological technique may also be \npotentially misleading. Patient age, location of the supposed \"abnormality\" and \nlack of significant local symptoms are key factors. Usually plain films, \ncorrelated with regional clinical findings, are the only imaging method that is \nrequired. However, in certain doubtful situations, ultrasound, CT, MRI, bone \nscan, or even biopsy may be needed to reach the right diagnosis. Unnecessary \noveruse of these imaging modalities, and the subsequent family anxiety that \nensues from this overuse, should be avoided with careful analysis of the X-ray \nand clinical findings.  \nLearning Objectives:\n1. To learn about normal variants in the neonatal and paediatric \nmusculoskeletal system. \n2. To become familiar with the imaging appearances of common normal \nvariants. \n3. To understand how to differentiate between normal variants and disease. \n4. To learn how to integrate age, location and clinical history with the \nradiological features before establishing a diagnosis. \n14:00 - 15:30 Room E1  \nMusculoskeletal  \nRC 1410  \nHow I do and report  \nModerator:  \nF. Kainberger; Vienna/AT \nA-421 14:00 \nA. MRI of the hip  \nJ. Teh; Oxford/UK (jamesteh1@googlemail.com) \nThe purpose of this lecture is to cover the clinical presentation, underlying \npathological processes and essential MRI features of relatively common \nconditions affecting the hip. As the hip is afflicted by different conditions \naccording to age, this is how the various pathological entities will be presented. \nA simple imaging algorithm is presented showing the role of MRI. The role of \nMR arthrography in the assessment of the dysplastic hip and femoro-\nacetabular impingement is covered. A structured approach to MRI reporting is \noutlined.  \n\nA B C D E F G S94  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To learn about standardised imaging. \n2. To understand the MRI specific findings that aid diagnosis. \n3. To learn a structured approach to reporting. \nA-422 14:30 \nB. MRI of the spine and sacroiliac joints  \nA. Feydy; Paris/FR (antoine.feydy@cch.aphp.fr) \nMRI is the preferred imaging modality for spinal and SIJ imaging in patients \nwith suspected or established spondyloarthropathies (SpA). There is a need to \nperform standardised and efficient MR prot ocols in this clinical setting. The \nmain goals are to detect inflammatory active lesions and also structural \nlesions. In addition, the MRI should be  able to diagnose other diseases such \nas disk degenerative disease, DISH, or metastases in patients with \nnonconfirmed SpA. A systematic approach is recommended for MRI reading. \nThe radiologist report has to focus on the more specific MRI findings of SpA, if \npresent, and to give a conclusion regarding the activity and the structural \ndamages.  \nLearning Objectives:\n1. To learn standardised imaging. \n2. To understand the MRI specific findings that aid diagnosis. \n3. To learn a structured approach to reporting. \nA-423 15:00 \nC. MRI of the hand  \nC. Schueller-Weidekamm; Vienna/AT\n(claudia.schueller-weidekamm@meduniwien.ac.at) \nMRI of the hand requires high spatial resolution, perfect immobility, and \nhomogeneous fat suppression. The hand can either be placed in the \nSuperman position, which often is uncomfortable for the patients, or both \nhands can be placed above the abdomen next to each other while the patient \nis in the supine position. Standard sequences are axial PD, followed by coronal \nT1 TSE, and T2 TSE FS in the coronal and sagittal planes. Additional 3D \ngradient echo sequences with fat saturation are recommended to assess \nligaments and cartilage, as well as the triangular fibrocartilage complex \n(TFCC). In certain cases, MR arthrography with thin-slice T1 FS is helpful for \nfurther evaluation of the wrist ligaments. In inflammatory diseases, such as \nrheumatoid arthritis, static or dynamic T1 FS sequences are useful to assess \ntenosynovitis and synovitis. The most common injuries and inflammation of the \nhand and wrist are discussed with speci al emphasis on key findings for an \naccurate diagnosis. The awareness of advantages and drawbacks of other \nimaging modalities, such as conventional radiographs and CT, should be \nstrengthened. The clinical impact of the radiological report is discussed to \nstrengthen the importance of proper terminology for the description of \npathological findings. The structure of the report should be clear and concise, \nand should allow an interaction and broad communication with clinicians.  \nLearning Objectives:\n1. To learn about standardised imaging. \n2. To understand the MRI specific findings that aid diagnosis. \n3. To learn a structured approach to reporting. \n14:00 - 15:30 Room E2  \nOncologic Imaging  \nRC 1416  \nGastro-entero-pancreatic neuro-endocrine \ntumours (GEP-NET): a multidisciplinary \nupdate\nA-424 \n14:00 \nChairman's introduction  \nC. Matos; Brussels/BE (cmatos@ulb.ac.be) \nGastro-enteropancreatic neuroendocrine tumours (GEP-NET) are a \nheterogeneous group of cancers that differ in their biology and clinical \npresentation. Diagnosis of these tumours has been improved by advances in \npathology and classification and by the com bined use of structural imaging and \nfunctional imaging modalities. Multimodal imaging is increasingly recognised \nboth in detecting and staging disease and also in characterising biological \npatterns of lesions that may be relevant to the selection and delivery of \ntherapy. In this course, the complex nature of GEP-NET and the intrinsic uses \nand limitations of each diagnostic imaging modality will be underlined. Insights \nto hybrid structural and molecular imaging techniques will be provided and \ndiscussed.  \nA-425 14:05 \nA. Tumour biology, pathogenesis and classification  \nB. Wiedenmann; Berlin/DE (bertram.wiedenmann@charite.de) \nNeuroendocrine tumour cells are characterised by the coexpression of \nneuronal and epithelial proteins and cellular organelles such as synaptic \nvesicles containing synaptophysin of neurons and intermediate \nfilaments/cytokeratins of the epithelial cells. Based on the presence of \nsecretory vesicles and the continous, uncontrolled vesicular release of biogenic \namines, neuropeptides and hormones, patients suffer in half of the cases of so \ncalled functional symptoms and syndromes. Examples are the carcinoid \nsyndrome (excessive release of serotonine) or the Zollinger-Ellison syndrome \n(excessive release of gastrin). Activation or inhibition of certain G-protein \ncoupled receptors (e.g. somatostatin receptors) or channel proteins (R-type \ncalcium channels) can lead to the control of the hypersecretion or so called \nfunctionality of the affected patients. Medical interference with signal \ntransduction pathways involving tyrosine kinase receptors as such mTor and \nchannel proteins can lead to an inhibition of cellular and tumour growth. These \nobservations have led to the establishment of new therapies, especially for \npancreatic NETs using especially mTor and tyrosine kinase inhibitors. Whereas \nthe tumorigenesis is unknown in the case of sporadic NETs, hereditary NETs \nappear to develop via a menin mutation through the intermediate stage of \nhyplasia before they develop the full me tastatic potential. Based on the above \ngiven tumour biological and histopathological findings, a rather robust \nclassification for NETs has been devel oped by the European Neuroendocrine \nTumor Society (ENETS) using a TNM-cl assification together with a grading-\nsystem. Furthermore, the formerly used terms such as APUDOMa, \nNeurocrestoma, Carcinoid, etc. have been largely replaced by the meanwhile \ngenerally accepted term neuroendocrine tumour.  \nLearning Objectives:\n1. To learn about the basic aspects of GEP-NET biology, pathogenesis and \nclassification. \n2. To understand the epidemiology and current treatment options. \n3. To become familiar with rational clinical management. \nAuthor Disclosure:\n B. Wiedenmann: Advisory Board; Novartis, IPSEN Biotech, Pfizer. Speaker; \nNovartis, IPSEN Biotech. \nA-426 14:28 \nB. The current role of nuclear medicine  \nC. Deroose; Leuven/BE (christophe.deroose@uzleuven.be) \nThis presentation will focus on the pivotal role of nuclear medicine in the \ndiagnosis and treatment of neuroendocrine tumours (NETs). The metabolic \nand molecular imaging capabilities of both positron emission tomography \n(PET) and single photon emission tomography ( SPECT) have made a great \nimpact on the clinical management of patients with these tumours. A poster \nchild of molecular imaging in oncology is scintigraphy of the somatostatin \nreceptor (SSR). \n111In-DTPA-octreotide has a substantial value in detection, \ndiagnosis and staging of NET and more particularly in gastroenteropancreatic \nNETs. Newer SSR-binding radiopharmaceuticals have been developed for \nPET, mainly with gallium-68 as radiolabel, with higher affinity and more \nadvantageous pharmacokinetics. When used with high-resolution and rapid-\nthroughput multimodal whole body imaging of modern PET/CT cameras, these \ntracers provide the current state-of-the art SSR imaging. We will also discuss \nthe clinical value of metabolic tracers, such as [\n18F]-FDG for glucose \nmetabolism imaging, [ 18F]-DOPA and [ 11C]-HTP ([11C]5-hydroxytryptophan) for \namino acid metabolism imaging. The clinic al merits and indications of these \ntracers will be explained. The continuously evolving quest to develop tracer for \nother receptor systems expressed on NETs will be illustrated, e.g. bombesin, \nVIP, CCK and glucagon-like peptide receptor ligands. Finally, the role of \nimaging as selection for metabolic and peptide receptor radionuclide therapy \nwill be discussed.  \nLearning Objectives:\n1. To learn about the cellular properties and GEP-NET used in molecular \nimaging. \n2. To become familiar with the different modalities and new tracers being used. \n3. To learn about the performance of the different methods available. \nAuthor Disclosure:\n C. Deroose: Advisory Board; Merck; Endocyte. \nA-427 14:51 \nC. Anatomical imaging: transabdominal US, endoscopic US, MDCT and \nMRI: which is the most appropriate imaging approach?  \nV. Vilgrain, M.-P. Vullierme, P. Ruszniewski, A. Sauvanet; Clichy/FR\n(valerie.vilgrain@bjn.aphp.fr) \nGastroenteropancreatic neuroendocrine tumours (GEP-NETs) are a \nheterogeneous group of neoplasms that arise from cells of the diffuse \nneuroendocrine system and may present with a wide spectrum of clinical \n\nA B C D E F G S95  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\npresentations. Their prognosis is mainly related to their biology, proliferation \nand differentiation. The main goals of imaging are the diagnosis and the \nstaging of these tumours. The diagnostic challenge is very different in \nfunctional tumours where clinical presentation and laboratory parameters are \nof utmost importance and in nonfunctional tumours where imaging may show \ncharacteristic features such as hyperva scularisation and calcifications. Staging \nis also essential as locoregional involvement and distant metastases (such as \nliver metastases) may change the therapeutic approach and are major \nprognostic factors. Multimodal workup included morphological imaging \nmodalities with CT and MR imaging, and endoscopic ultrasound was the most \nuseful and functional imaging. The latter includes somatostatin receptor \nscintigraphy, FDG PET and more recent functional tools such as PET using \n68Ga and 18 F-DOPA. Imaging may also play a role in assessing prognosis in \ncombination with tumour differentiation and tumour proliferation, obtained from \npathologic examination. Last, imaging is useful in evaluating tumour response \nafter treatment. Although surgery remains the only potentially curative therapy \nfor patients with primary GEP-NETs, other available treatments include \nchemotherapy, interferon, somatostatin analogues, and targeted therapies. \nImaging criteria rely not only on changes in tumour size, but also on internal \ntumour changes.  \nLearning Objectives:\n1. To learn how to recognise the specific imaging features of GEP-NET. \n2. To learn about the strengths and weaknesses of the different imaging \nmodalities. \n3. To understand the optimal use of the different imaging modalities in relation \nto tumour location and staging. \nPanel discussion:  \nThe future of hybrid imaging  \n15:14\n14:00 - 15:30 Room F1  \nSpecial Focus Session  \nSF 14a  \nAssessment of brain perfusion with \narterial spin labelling (ASL)  \nA-428 14:00 \nChairman's introduction  \nX. Golay; London/UK (x.golay@ucl.ac.uk) \nThe purpose of this session is to bring the audience up to date with a novel \nMRI method capable of measuring brain perfusion. This method is called \narterial spin labelling (ASL) and provides a complete non-invasive means to \nquantitatively assess cerebral blood flow (CBF). As with any MRI technique, \nASL relies on proper setting of many technical parameters to provide an \nadequate image quality, with minimal influence from potential artefacts. A \nrecent position paper, co-signed by members of the Perfusion Study Group \nfrom the International Society for Magnetic Resonance in Medicine and the \nEuropean COST-funded Action on 'ASL in Dementia', has established a series \nof simple guidelines to help promote th is technology in clinical practice. These \nguidelines will be provided within this session. The created CBF maps will then \nbe analysed, and a simple description of the main features and clinical \ncharacteristics of these physiological images will be given to the audience. In \nparticular, a proper difference in the m eaning of CBF in several diseases will \nbe highlighted, as it can be either causative, such as e.g. in stroke and \ncerebrovascular diseases, where a reduced CBF leads to a breakdown in \ntissue homeostasis, or consequential, as in e.g. dementia, in which a reduction \nof CBF is the mere reflection of impaired metabolism, combined or not with an \nunderlying brain atrophy. Following this session, the radiologist or clinician \nshould be able to better appreciate ASL-based SBF maps in several \nneurological conditions.  \nSession Objectives: \n1. To understand which elements are key to ensuring the optimal estimation of \ncerebral blood flow by ASL. \n2. To become familiar with the imaging features of ASL. \n3. To understand the clinical role of ASL in neurological diseases. \nAuthor Disclosure:\n X. Golay: Research/Grant Support; Philips Healthcare. \nA-429 14:05 \nAn introduction to ASL, its jargon and methods  \nM. Guenther; Bremen/DE (Matthias.Guenther@mevis.fraunhofer.de) \nPerfusion is an important parameter to assess the status and liability of organs \nand tissue. Typically, exogenous contrast agents are administered to measure \nthis quantity. Arterial spin labelling (ASL) is capable of estimating perfusion \nwithout the use of exogenous contrast media by labelling inflowing blood \nmagnetically. This labelling process can happen either in a short time over an \nextended region or over a longer time period, but in a localised area. These \ntechniques are called pulsed ASL (PASL) or continuous ASL (CASL), \nrespectively. For quantification, a criti cal parameter is the time the labelled \nblood takes to flow from the region of labelling to the imaging region. This time \nis typically called bolus arrival time (BAT ) or arterial transit time (ATT). It is \nimportant to either reduce the influence of thi s transit time on measured signal \nintensity or directly estimate it. Appl ying proper bio-physical models, the \nperfusion-weighted data can then be converted in absolute measures of \nperfusion. More sophisticated methods allow measuring of the main feeding \nartery of each imaging voxel (vascular territory mapping) or assessing other \nparameters beyond perfusion, allowing more detailed assessment of tissue \nstatus and function.\"  \nLearning Objectives:\n1. To learn the basics of ASL, its methods and proposed implementation in \nclinical platforms. \n2. To understand the influence of parameter choices on perfusion images. \n3. To become familiar with basic quantification techniques in ASL. \nAuthor Disclosure:\n M. Guenther: CEO; mediri Gmbh, Heidelberg, Germany. Research/Grant \nSupport; Siemens Healthcare, Erlangen, Germany. \nA-430 14:28 \nThe use of ASL in cerebrovascular disease  \nJ. Hendrikse; Utrecht/NL (j.hendrikse@umcutrecht.nl) \nObvious applications of arterial spin labelling in clinical MR protocols are \ncerebral blood flow measurements in patients with acute or chronic \ncerebrovascular disease. In patients with acute stroke, the cerebral blood flow \nmeasurements may indicate the infarct core, with severely decreased \nperfusion and the infarct penumbra, with decreased perfusion but still viable \nbrain tissue. In chronic cerebrovascular disease, arterial spin labelling CBF \nmeasurements show the regionally impaired haemodynamics distal to a carotid \nobstruction. With adequate collateral blood flow, these areas may be relatively \nsmall and with a failure of compensatory mechanism the cerebral blood flow \nmay fall below a critical level. In acute stroke patients, ASL MRI may show \ncompensatory hyperperfusion in stroke regions after the recanalisation of an \noccluded artery. Other applications of arterial spin labelling are clinical MR \nprotocols in children. In addition to CBF-weighted images, ASL MRI has also \nthe ability to measure timing parameters: typically, the time it takes for the \nmagnetically labelled arterial blood to flow  from the arteries in the neck to the \nbrain tissue, which may be delayed in patients with cerebrovascular disease. \nFurthermore, ASL MRI has the ability to visualise the (collateral) perfusion \nterritories of the brain feeding arteries in many clinical applications. In patients \nwith cerebrovascular disease, a pitfall may be the absence of label in brain \nregions due to delayed (collateral) flow, which also may result in high ASL \nsignals in (collateral) arteries.  \nLearning Objectives:\n1. To appreciate the different roles of ASL in cerebrovascular diseases. \n2. To become familiar with the different types of calculated images obtained \nfrom multi-time points and selective pulses ASL. \n3. To become familiar with the limitations and pitfalls of ASL. \nA-431 14:51 \nThe use of ASL in non-vascular brain disease  \nM. Smits; Rotterdam/NL (marion.smits@erasmusmc.nl) \nArterial spin labelling (ASL) is a non-invasive MRI technique with which \ncerebral blood flow (CBF) can be measured quantitatively. Although the first \npublications of ASL MRI date over 10 years back, it is only now that ASL is \ncommercially available on MRI systems from all major vendors and is making \nits way into clinical practice. The main areas of interest for current and future \nnonvascular clinical application of ASL MRI of the brain are dementia and \nneuro-oncology. ASL is proposed as a diagnostic alternative to fluorodeoxy-D-\nglucose (FDG)-PET in the workup of dementia patients. ASL has several \nadvantages over FDG-PET. Crucially, it can easily be added to the routinely \nperformed structural MRI examination. Feasibility studies show that ASL \nprovides reliable CBF maps in dementia. In patients with established \nAlzheimer's disease and frontotemporal dementia, hypoperfusion patterns are \nseen that are similar to hypometabolism patterns with FDG-PET. Current and \nfuture studies in this field will need to demonstrate the validity of ASL in the \ndiagnostic workup of the individual patient, early in the disease process. \nStudies on ASL in brain tumour imaging indicate a high correlation between \nareas of increased CBF as measured with ASL, and increased cerebral blood \nvolume as measured with dynamic susceptibility contrast-enhanced perfusion \nimaging. The major advantages of ASL for brain tumour imaging are the fact \nthat CBF measurements are not influenced by breakdown of the blood brain \nbarrier, as well as its quantitative nature, facilitating multicentre and \nlongitudinal studies.  \n\nA B C D E F G S96  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To understand the role of ASL in non-vascular brain disease. \n2. To become familiar with current and future indications for the use of ASL in \nnon-vascular brain disease. \n3. To appreciate the limitations and pitfalls of ASL. \nPanel discussion:  \nHow relevant is ASL in clinical practice today?  \n15:14\n14:00 - 15:30 Room F2  \nBreast  \nRC 1402  \nUpdate on BI-RADS  \nModerator:  \nM.G. Wallis; Cambridge/UK \nA-432 14:00 \nA. Mammography  \nU. Bick; Berlin/DE (Ulrich.Bick@charite.de) \nThe Breast Imaging Reporting and Data System (BI-RADS®) for \nmammography of the American College of Radiology (ACR®) consists of \nseveral components, a standardised lexicon of terms to be used during \nreporting, a 4-step coding system for the mammographic density as a \nsurrogate parameter for the mammographic sensitivity, and a group of \nassessment categories ranging from 0 to 6 for structured communication \nregarding the recommended further management. The goal of BI-RADS® is to \nimprove the quality of breast imaging reporting and communication. In addition, \nby providing structured reports it facilitates regular quality assurance \nmeasures. The BI-RADS® atlas for mammography is currently in its fourth \nedition and was released in 2003. The upcoming 5\nth edition is expected soon \nand will be incorporated into the course as it becomes available.  \nLearning Objectives:\n1. To learn about the BI-RADS lexicon. \n2. To understand the usefulness of BI-RADS system. \n3. To become familiar with the mammography descriptors. \nA-433 14:30 \nB. Ultrasound  \nF. Thibault; Paris/FR (fabienne.thibault@curie.fr) \nThe Breast Imaging Reporting and Data System (BI-RADS) was first \ndeveloped by the American College of Radiology for standardising the \nreporting of mammography. Since its first publication in 1993, new editions \nhave also addressed breast ultrasound (US) and MR imaging examination. \nThe new (fifth) edition will be published soon. On the form, this new version \nwas designed to include a web-based format. Substance includes updates in \nlexicon descriptors, e.g. masses, calcifications, associated features (now \ncomprising surrounding tissue with stiffness assessment), and special cases. \nUS descriptors will be reviewed in the lecture. Of note, guidance on how to link \nBI-RADS descriptors with management recommendations has been added in \nthe report section. A new approach to outcome assessment (audit section) is \nbeing proposed for screening US. The appropriate use of descriptors is \nexpected to increase the accuracy of imaging interpretation. For relevant \npatient management, US analysis is to be integrated with other available \nimaging, as well as with clinical data.  \nLearning Objectives:\n1. To learn about the BI-RADS lexicon. \n2. To understand the usefulness of BI-RADS system. \n3. To become familiar with the ultrasound descriptors. \nA-434 15:00 \nC. MRI  \nK. Pinker-Domenig, P.A.T. Baltzer; Vienna/AT\n(katja.pinker@meduniwien.ac.at) \nDynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of the \nbreast is a well-established non-invasive imaging technique. It has clinical \napplication in the screening of high-ri sk patients, diagnosis and staging of \nbreast cancer, monitoring neoadjuvant chemotherapy and post-treatment \nfollow-up. To standardise the reporting of DCE-MRI of the breast and minimise \nfalse-positive results without compromising sensitivity, the American College of \nRadiology (ACR) introduced the Breast Imaging-Reporting and Data System \n(BI-RADS®) MRI lexicon in 2003. BI-RADS relies on the combined analysis of \nmorphological appearance and lesion enh ancement kinetics. It is widely used \nfor reporting DCE-MRI of the breast and is applicable at any given field \nstrength. It aims to provide an up-date report on the BI-RADS® lexicon and \ninstill confidence in using BI-RADS® descriptors. The BI-RADS® system may \nbe placed in a broader clinical context  to highlight its value for standardised \nreporting of DCE-MRI of the breast.  \nLearning Objectives:\n1. To learn about the MRI BI-RADS® lexicon. \n2. To learn how to recognise the descriptors defined in the MRI BI-RADS® \nlexicon. \n3. To understand the clinical relevance of the BI-RADS® system and apply the \nBI-RADS® lexicon when reporting MRI of the breast. \n14:00 - 15:30 Room G/H  \nSpecial Focus Session  \nSF 14b  \nTreatment with MR-guided focused US \n(FUS)  \nA-435 14:00 \nChairman's introduction  \nW.M.W. Gedroyc; London/UK (w.gedroyc@imperial.ac.uk) \nMR-guided focused ultrasound is a new therapeutic modality which can allow \nselective destruction and or heating of tissues in deep body areas under close \nimage guidance control. These talks will introduce the field and allow you to \nunderstand the areas of current work and areas of future development in this \nrapidly expanding field.  \nSession Objectives: \n1. To become familiar with MR-guided focused ultrasound. \n2. To understand the advantages of focused ultrasound. \n3. To learn in which areas focused ultrasound is evolving successfully. \nA-436 14:05 \nDescription of technique  \nC. Moonen; Utrecht/NL (C.Moonen@umcutrecht.nl) \nHigh-intensity focused ultrasound (HIFU) is the only clinically viable technology \nthat can be used to achieve a local temperature increase deep inside the \nhuman body in a non-invasive way. MRI guidance of the procedure allows in \nsitu target definition and iden tification of nearby heal thy tissue to be spared. In \naddition, MRI can be used to provide continuous temperature mapping during \nHIFU for spatial and temporal control of the heating procedure and prediction \nof the final lesion based on the received thermal dose. The primary purpose of \nthe development of MR-guided HIFU was to achieve safe non-invasive tissue \nablation. The technique has been tested extensively and is now accepted in \nthe clinic for ablation of uterine fibroids. MR-guided HIFU for ablation shows \nconceptual similarities with radiation therapy. However, thermal damage \ngenerally shows threshold-like behaviour with necrosis above the critical \nthermal dose and full recovery below. MR-guided HIFU is being clinically \nevaluated in the cancer field. This presentation will cover the basic \ntechnologies for treatment of stationary tissues, and some advances towards \ntreatment of mobile abdominal organs.  \nLearning Objectives:\n1. To learn how MR-guided focused ultrasound is generated. \n2. To understand the current physical limitations of this technique. \n3. To learn how the technology is being improved to overcome the limitations \nof administering focused ultrasound to patients. \nAuthor Disclosure:\n C. Moonen: Research/Grant Support; Philips Healthcare. \nA-437 14:28 \nUterine fibroids and adenomyosis  \nY. Inbar; Tel Hashomer/IL (Yael.Inbar@sheba.health.gov.il) \nMagnetic resonance imaging-guided focused ultrasound (MRgFUS) for the \nnoninvasive treatment of uterine fibroids ha s been used in a clinical setting \nsince 2003. During the past decade, many improvements have been made in \nthe treating systems, making treatments easier, faster, safer and fitting a wider \nrange of patients. In this presentation, I will talk about the advances made over \nthe years in the MRgFUS systems, helping to overcome many previously \nencountered obstacles. We will discuss patient selection and suitability and \nreview the current success rates of the procedure. In addition, we will address \nthe issue of adenomyosis, another uterine pathology frequently encountered \nthat can produce symptoms similar to uterine fibroids. For these patients \ntreatment options are extremely limited, making MRgFUS an attractive \ntreatment option.  \n\nA B C D E F G S97  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To learn which patients are suitable for MR-guided focused ultrasound of \nuterine fibroids. \n2. To understand the current success rates of this procedure. \n3. To appreciate the outcome of FUS is in the treatment of adenomyosis of the \nuterus. \nAuthor Disclosure:\n Y. Inbar: Research/Grant Support; Insightec. \nA-438 14:51 \nTranscranial FUS  \nE. Martin; Zurich/CH (Ernst.Martin@kispi.uzh.ch) \nTranscranial focused ultrasound (tcMR gFUS) is a novel technique for \nnoninvasive neurosurgical interventions, that is magnetic resonance imaging \nguided for target definition and treatment planning with continuous temperature \nmeasurements in real time. TcMRgFUS has no trajectory restrictions and does \nnot involve ionising radiation. The ability  to focus ultrasound energy through \nthe intact skull precisely to desired targets, while avoiding collateral brain \ntissue damage, thus, minimising adverse eff ects by mistargeting is certainly \nattractive. Since no device is implanted, there is no restriction to future \ndiagnostic workup with high-field MR imaging. TcMRgFUS allows treating a \nvariety of chronic, therapy-resistant neur ological diseases by focusing high-\nintensity ultrasound energy (HIFU) to the thalamus, subthalamus or basal \nganglia. Ongoing clinical studies on over 130 patients with neuropathic pain, \nessential tremor, Parkinson's disease and obsessive compulsive disorder are \nvery encouraging. They promise tcMRgFUS to become a noninvasive \nalternative treatment option for patients with therapy-resistant neurological and \nneuropsychiatric disease. Moreover, ablation of pathological tissue as in brain \ntumours and brain metastases is urgently needed to supplement traditional \nneurosurgical procedures. Future trends: preclinical studies using low-intensity \nfocused ultrasound (LIFU) have shown to silence dysfunctional neuronal \ncircuits and to transiently modulate neural functions. This eventually may lead \nto better targeting during functional neurosurgical interventions such as FUS \nand DBS. Moreover, in combination with microbubbles, LIFU pulses enable \nopening of the blood-brain-barrier, facilitating drug delivery to specific targets in \nthe brain. Conclusion: TcMRgFUS promises new therapeutic approaches for \na variety of brain diseases that may change patient management.  \nLearning Objectives:\n1. To understand how focused ultrasound can be utilised in the brain. \n2. To learn which conditions can be treated successfully. \n3. To understand how this technique will evolve and what role it will play in the \nmanagement of chronic and acute neural conditions. \nPanel discussion:  \nHow can this technology be spread more widely?  \n15:14\n14:00 - 15:30 Room I/K  \nHead and Neck Imaging  \nCC 1419  \nWhat do I see? Clinical radiological \ninteraction (part 2)  \nModerator:  \nB. Ozgen Mocan; Ankara/TR \nA-439 14:00 \nA. Presurgical and postsurgical imaging: free flap reconstructions  \nA. Trojanowska, P. Trojanowski; Lublin/PL\nThe use of microvascular free flaps for reconstructions allowed for the \ndevelopment of extensive resections of head and neck tumours. Radiological \nevaluation of patients subjected to reconstructive operations using free flaps \nrequires the in-depth knowledge of flap structure and anatomy. Imaging allows \ndelineation of the tumour and planning the extent of resection. Availability of \nreconstructive surgery extends the scope of surgical intervention, but requires \nmeticulous consideration of the choice of flaps. It is necessary to investigate \nwith imaging the donor site to ensure adequate flap size, shape and \nvasculature. At the same time it is of paramount importance to assure that flap \nharvesting does not endanger functionality and blood supply to the donor site. \nImaging studies of the donor site can reveal vascular abnormalities and \ntherefore prevent acute and chronic donor site ischemia. In the follow-up of \npatients with transplanted tissues, specific difficulties in detecting recurrence \nexist because there is an altered anatomy. This lecture is based on the \ninterpretation of CT and MR cases illustrating follow-up of microvascular free \nflaps used for the reconstruction of defects resulting from head and neck \ncancer surgery, with particular attention to the role of radiologic-clinical \ncooperation for the appropriate interpretation of imaging findings.  \nLearning Objectives:\n1. To become familiar with major flap types used for head and neck \nreconstructions and the importance of reconstructive surgery. \n2. To understand how to evaluate images for surgery planning. \n3. To learn how to perform follow-up studies in patients after free flap \nreconstructions in order to avoid possible pitfalls. \nA-440 14:30 \nB. Sinonasal imaging for functional endoscopic sinus surgery (FESS)  \nV. Lund, G. Madani; London/UK\nComputerised tomography offers the gold standard in terms of imaging the \nextent of disease and the fine detailed anatomy, both pre-requisites to the safe \npractice of endoscopic sinus surgery (ESS). A variety of protocols minimising \nradiation dose to the lens whilst providing high-quality images have been \ndescribed, depending on the scanner and whether image guidance is being \nused. In general for ESS in chronic rhinosinusitis with or without nasal polyps, \ncoronal and axial views are suffici ent though sagittal cuts are recommended \nwhen surgery on the frontal sinus is contemplated. The anatomy varies \nconsiderably on an individual basis and includes a range of anatomic variants, \nwhich although do not predispose to the di sease, require careful evaluation \npre-operatively. MRI plays a limited role in benign inflammatory disease, \nthough it may be undertaken secondarily when the diagnosis is unclear.  \nLearning Objectives:\n1. To learn about common sinonasal pathologies. \n2. To understand why we use FESS and what information is needed to plan a \nsurgery. \n3. To learn about several interesting cases in order to understand the \nimportance of cooperation between the radiologist and clinician. \nA-441 15:00 \nC. Sinonasal tumours: key clinical questions  \nV. Lund1, N.J.M. Freling2; 1London/UK, 2Amsterdam/NL \nThe analysis of a sinonasal tumour requires MRI for differentiation between \ntumour and secretions or polyps, to assess the local extension and spread into \nadjacent compartments (skull base, intracranial, orbit, deep facial \ncompartments) and to depict perineural spread. T2, T1 and high-resolution \npostcontrast series preferably in three, but at least in two different planes, are \nneeded. CT provides additional information of bony structures and serves as a \nroad map for surgical navigation. A fascinating benign sinonasal tumour is \ninverted papilloma, which has a high recurrence rate if not removed in toto and \nmay harbour carcinoma in < 5% of patients. CT may show the attachment of \nthe tumour as an area of increased sclerosis, which directs the surgeon to plan \nthe operation. In patients with recurrent inverted papilloma, providing \ninformation to the radiologist about its presumed localisation is important, the \nmore so in patients suffering from polyposis. Malignant tumours are uncommon \nand of a large histologic variety. About 80% arise in the maxillary sinus; 70% \nare squamous cell carcinomas. They are often large at diagnosis, because \nclinical symptoms of nasal obstruction or headache are non-specific. Diagnosis \nis by biopsy. In view of the rapid development of advanced endoscopic \ntechniques, preoperative imaging is extremely important to assess accurately \ntumour extension. The skull base and dura as well as the lamina papyracea \nshould be scrutinised for tumour locati ons to foresee an additional cranio-\nendoscopic approach to a standard endo nasal endoscopic approach. Finally, \nimaging may play a role in differentiating non-nasal disease, e.g. primary bone \ntumours, from mucosal disease.  \nLearning Objectives:\n1. To learn about the most important sinonasal tumours and techniques for \ntheir evaluation. \n2. To become familiar with key surgical questions and contraindications for \nsurgery. \n3. To learn about several cases in order to understand the role of clinical-\nradiological cooperation. \n\nA B C D E F G S98  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n14:00 - 15:30 Room L/M  \nPhysics in Radiology  \nRC 1413  \nGood radiation and bad radiation?  \nHow to assess and communicate radiation \nrisk to patients and referring physicians  \nModerators:  \nM.M. Rehani; Vienna/AT \nP. Vock; Spiegel/CH \nA-442 14:00 \nA. Radiation risk: a patient's perspective  \nN. Bedlington; Vienna/AT (nicola.bedlington@eu-patient.eu) \nTo discuss risk/benefit considerations in m edical imaging from the perspective \nof patients and highlight some of the pre-requisites to ensure trust and \nconfidence. This presentation will draw on the work of the European Patients' \nForum on patient safety, quality of care, health literacy, and patient \nempowerment, to explore what are the key factors to consider in radiation risk \nanalysis, from a patient's perspective, recognising that 'one size does not fit \nall'. It will examine what constitutes quality information in this environment, \neffective dialogue between the patient and the radiologist, and the \ninterdisciplinary team, informed consent and transparency of data. It will also \nhighlight some of the particular challenges regarding vulnerable patients, and \nthose requiring on-going treatment due to chronic disease (s).  \nLearning Objectives:\n1. To understand the fears of patients. \n2. To learn what's expected from physicians and techs. \n3. To learn about ideal communication strategies. \nA-443 14:15 \nB. Radiation risks for patients and staff  \nP. Gilligan; Dublin/IE (PGilligan@materprivate.ie) \nThe justification for medical procedur es is based on the assumption that the \nbenefit outweighs the risk. This presentati on looks at the radiation risk factors \nfrom recent high-profile papers (Pearce et al., 2012) and publications from \ninternational bodies such as BEIR and ICRP. At lower radiation doses ( < 100 \nmSv), quantifying, understanding and communicating radiation risk to staff, \npatients and referring clinicians presents a range of challenges. Advances in \nhealth information systems will facilitate more precise dose risk relationships. \nThere are a number of approaches to stochastic radiation risk assessment \nsuch as organ-/age-based assessment and effective dose equivalent \nassessment. At-risk groups, such as children and pregnant women, need \nspecial focus. EU directives demand spe cial attention for high-dose \ninterventional procedures and CT scans. These techniques, particularly if \nrepeated, require further risk assessment regarding potential deterministic \neffects such as erythema, hair loss, and radiation-induced cataractogenesis. \nThis paper looks at strategies in consenting, monitoring, and follow-up of such \nhigh-dose effects. The practical implications of the new occupational ICRP eye \ndose limits for interventional practice are also examined.  \nLearning Objectives:\n1. To get the latest information on stochastic risks in radiology. \n2. To understand the risks for children as compared with adults. \n3. To get the latest information on tissue reaction to medical procedures. \n4. To learn about radiation cataract and its dose dependence. \nA-444 14:40 \nC. Risk in MRI  \nR. Peeters; Leuven/BE (ronald.peeters@uzleuven.be) \nWith the advent of higher field scanners in clinical practice and the construction \nof 'MRI compatible' implanted devices, the list of the do's and don'ts while \nperforming an MRI examination changes constantly. In this presentation basic \nsafety guidelines and rules will be explained regarding static magnetic field \neffects, time varying magnetic field effects, radiofrequency field effects and \nacoustic noise effects both with regard to the patient as well as the personnel \nusing the equipment. Due to the advances in medical technology the list of \npossible 'safe' and 'unsafe' items changes almost daily. Therefore it is very \nimportant to have all the information about the patient's condition and implants \nprior to the MRI procedure in order to asses possible contraindications in \nadvance. While until a couple of years ago cardiac pacemakers and \nneurostimulators were contraindicated in the MRI environment, the advent of \n'MRI compatible' pacemakers and other implanted devices introduces \nchallenges in patient safety. In fact these devices are only safe in certain \nconfigurations and also in a lot of cases specific MRI scan sequences and RF \nantennas are only allowed. Following the European EMF directive, where the \nMRI part is derogated, the protection of staff working with EM fields also \nbecame a topic of debate. What are the possible risks for staff working with \nMRI magnets and how can one implement practical rules for the safe use of \nthe MRI equipment.  \nLearning Objectives:\n1. To learn about the risks for patients from MRI procedures. \n2. To learn about the contraindications for MRI scans. \n3. To learn about risks for staff in an MRI department. \nA-445 15:05 \nD. Communicating risks to patients and the public  \nN. Leitgeb; Graz/AT \nRisk communication is much more than just talking about an issue. It requires \nspecific background knowledge and skills. It needs to be based on adequate \nfacts of risk assessment such as provided by SCENIHR, the strength of \nevidence and remaining uncertainties. While evidence for health-relevant \neffects is convincing for X-ray imaging, and heating effects due to absorption of \nradio-frequency electromagnetic fields (RF-EMF) are well understood in MRI, \nthe existence of adverse stochastic side-effects from exposure to MRI RF-EMF \nis less clear since they have been classified as possibly carcinogenic (class \n2B) by WHO’s IARC. Little is known about potential health ri sks from ultra-high \nstatic magnetic fields used in MRI. The still frequent use of gynecologic \nultrasonic imaging for non-medical purpos es such as for generating videos for \nparents (baby cinema) in spite of the ban in established guidelines \ndemonstrates that risk awareness varies among physicians and parents.  \nThis can be explained by the fact that risk perception mechanisms are complex \nand risk perception almost uncoupled from quantitative risk levels. \nConsequently, in addition to sound fa ctual knowledge, risk communication \nrequires specific skills to help avoiding the numerous communication pitfalls \nsuch as using inadequate language, in particular gobbledygook, incorrect \nsimplifications, inadequate parameters, misleading wording, tricky comparisons \nand ambiguous messages. Emotions and confusing mind models such as \nabout the vulnerability of newborn and children or about dose-response \nrelationships need also to be taken into account. Another challenge is targeting \nrisk communication to stakeholders, in particular to lay people such as in \ncommunicating risks from inadequate behavior to patients with electronic \nimplants. \nLearning Objectives:\n1. To become familiar with communicating risk according to the imaging \nmodality. \n2. To become familiar with important rules in communication. \n3. To understand the relationship between threat/hazard and parents' \nperception regarding imaging for their child. \n4. To learn how to select a risk communications strategy suited to parents and \nchildren. \nAuthor Disclosure:\n N. Leitgeb: Other; European Commission’s Scientific Committee of Emerging \nand Newly Identified Health Risks (SCENIHR). \n14:00 - 15:30 Conf. Room M3  \nOncologic Imaging: Follow-up of Systemic and Local Therapies  \nCC 1418  \nFollow-up of thermal ablation (part I)  \nModerator:  \nP. Wiggermann; Regensburg/DE \nA-446 14:00 \nA. The zone of cell death and collateral phenomena in cross-sectional \nimaging: from histopathology to the standardisation of terms  \nA. Denys; Lausanne/CH (Alban.Denys@chuv.ch) \nThe field of image-guided ablation has expended recently with new ablation \ntechniques like micro-wave, irreversible electroporation, cryoablation. \nNevertheless, after each treatment, whatever the technique used, we will leave \nin place in the treated organ, a scar instead of the tumour. Follow-up of these \ntreated areas are done by radiologists using CT of MR or contrast enhanced \nultrasound. Standardisation of terms has been done in 2003 by an international \ncommittee presided by Dr. Goldberg. This allows reporting criteria identical \nfrom one center and from one country to another. Furthermore, it allows a \nmore homogeneous literature and evaluation of success. Nevertheless, \ntechniques are not all the same and the cellular and tissue damage in the \ntumour and around it in the healthy parenchyma are not identical and does not \nhave the same evolution over time.  \n\nA B C D E F G S99  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To understand histopathological changes after various ablation techniques. \n2. To become familiar with post-ablation imaging based on histopathological \ncorrelation of ablation zones in various organs. \n3. To learn about the correct terms for reporting and publishing on post-\nablation imaging. \nA-447 14:30 \nB. PET/CT for the evaluation of ablative therapy: Who? Where? When? \nDoes it help?  \nD. Deandreis; Villejuif/FR (Desiree.DEANDREIS@igr.fr) \nThermal ablation is frequently used to treat liver, lung and bone tumoural \nlesions because of its safety, efficacy and tolerability. One issue is the lack of \nreliable imaging modality to assess treatment efficacy and to detect early \nrelapse. Several papers have demonstrated that 18 FDG PET/CT is a useful \ntool to follow-up ablated liver tumour,  detecting residual disease easily and \nearlier than conventional imaging. Few reports evaluating the usefulness of \n18 FDG-PET/CT in the follow-up of ablated lung lesions are available, but \nprospective studies show promising resul ts, with a high negative predictive \nvalue of this technique. Very few data are available on bone lesions and further \nstudies are needed to assess the role of 18 FDG-PET/CT in the follow-up of \nthese lesions. In general, the in vivo typical aspect of completely ablated lesion \non 18 FDG-PET/CT is a ring shape, diffuse, peripheral, homogeneous 18 FDG \nuptake at the treated lesion; on the other hand, the presence of heterogeneous \nand focal uptake is more frequently related to disease relapse. SUVmax \n(Standardised Uptake Value) is not a reliable indicator. It is higher in case of \ndisease relapse than in completely ablated lesions, but also in case of \nimportant inflammatory reaction. Finally, the best time point to evaluate \nablation efficacy still remains to be defined, but 18 FDG-PET/CT should be \nperformed at least 3 months after treatment to avoid dubious or inconclusive \nfindings due to inflammatory reaction.  \nLearning Objectives:\n1. To understand who are the best candidates for a PET/CT follow-up of \nablation therapies. \n2. To learn what is the optimal timing of PET/CT in the follow-up of ablative \ntherapies. \nA-448 15:00 \nC. Everyday practice: MRI and CT for evaluating response to thermal \nablation  \nC. Dromain, C. Caramella, L. Vilcot, S. Ammari, F. Deschamps; Villejuif/FR\n(dromain@igr.fr) \nThe aim of thermal ablation treatment is to generate an area of \nthermocoagulation whose diameter is larg er or at least equivalent to that of the \ntumour. This necrotic scar usually shrinks with time, but most often very slowly. \nTherefore, the criteria of response based on size measurement cannot be \napplied. The pattern of thermal ablation is similar whatever the thermo-ablation \ntechnique used. On CT imaging, thermal ablation areas are well circumscribed \nand oval shaped. The criterion commonly used to assess the efficacy is the \nabsence of enhancement in the thermal ablation necrosis, which corresponds \nto tissue devoid of viable tumour. On MR imaging, the thermo-ablation areas \nare typically hyperintense on unenhanced T1 due to the presence of \nproteinaceous material, and hypointense on T2, explained by the dehydrating \neffect of thermal damage. The residual tumour is typically round in shape and \nlocated at the periphery of the necrotic area or in contact with large vessels. \nMR imaging allows earlier detection of residual liver tumour than CT imaging.  \nLearning Objectives:\n1. To become familiar with the imaging aspects of successful ablation. \n2. To learn about the main pitfalls of post-ablation imaging. \n3. To consolidate knowledge of the imaging aspects of most common \ncomplications. \nAuthor Disclosure:\n C. Dromain: Advisory Board; Roche, Novartis. Consultant; GE Healthcare. \nResearch/Grant Support; GE Healthcare. Speaker; GE healthcare, Roche, \nGuerbet, Pfizer. C. Caramella: Advisory Board; Roche. F. Deschamps:\nSpeaker; GE Healthcare. \n14:00 - 15:30 Board Room A  \nRadiographers  \nRC 1414  \nCutting-edge imaging: translating research \ninto clinical reality  \nA-449 14:00 \nChairman's introduction  \nC. Malamateniou; London/UK (christina.malamateniou@kcl.ac.uk) \nNeurodegenerative diseases, cancer and heart disease perhaps summarise \nthe major challenges to medicine in this century, a challenge in accurate \ndiagnosis and also in treatment. Rec ent technological advances in medical \nimaging technology mean that these challenges can be dealt with more \nefficiently. Anatomy can be studied faster, safer and with higher spatial \nresolution and precision. In addition to anatomy, the study of function has \nbecome feasible; more sophisticated hardware and software are being used to \nget the required data to map out the functionality and understand how this \nrelates to anatomy to offer a more comprehensive view of normal development \nand explain pathological conditions. At the same time, researchers and \nclinicians are urged to create a platform  for reciprocal communication to \nfacilitate translation of the research findings to a graspable clinical benefit for \nthe patients. This translational platform will allow flagging the major clinical \nquestions, inform current and future research experiments and at the same \ntime help utilise recent research findings in the clinical setting. This session will \nreview state-of-the-art MRI techniques and document different approaches to \ntranslational imaging. It will also allow understanding the obstacles and \nremedies in implementing translational medicine.  \nSession Objectives: \n1. To appreciate the impact of continued technological developments in \nmedical imaging on patient care. \n2. To understand the challenges of translating cutting-edge imaging \ntechnologies from research into clinical reality. \nA-450 14:05 \nA. Advanced imaging of neurodegenerative disease  \nE. Hughes; London/UK (emer.hughes@kcl.ac.uk) \nMany neurological diseases are associated with progressively reduced \ncognitive function. Recent evidence su ggests that proficient cognitive function \ndepends on an appropriate interaction between large-scale cognitive control \nnetworks in the brain. It is hypothesised that damage to white matter micro-\nstructure, as found in many neurological diseases, disrupts the integrated \noperation of these networks and results in impaired cognitive function. \nDiffusion tensor imaging (DTI) has been used to investigate alteration to white \nmatter micro-structure and resting state fMRI (rsFMRI) has proven to be a \nuseful technique to assess brain function in multiple cortical systems. However, \nthe combined use of these techniques in the clinical setting has not yet taken \nhold. In this presentation, I will demonstrate the flexibility of these MRI \ntechniques in assessing brain structure and function and address their \nfeasibility of use in a clinical setting.  \nLearning Objectives:\n1. To become familiar with advances and developments in neuro-MRI \ntechniques. \n2. To learn about state-of-the-art neuro-MRI research and the steps required to \nmake these techniques a clinical reality. \n3. To appreciate the role of the radiographer in advanced neuro-MRI. \nA-451 14:28 \nB. Advanced oncological imaging  \nL. Martí-Bonmatí; Valencia/ES (marti_lui@gva.es) \nImaging in oncology is a growing field within radiology. Different tomographic \ntechniques are used either isolated or as multimodality-multivariable imaging, \nas there is an increasing need to combine morphological and functional \ninformation. Different cutting-edge modalities, such as PET-CT, DW-MR, CE-\nMR and MR-spectroscopy, are standard in most clinical scenarios. New \nimages have advantages providing excellent soft-tissue contrast and \nmultidimensional functional, structural and morphological information. The \ndevelopment of new diagnostic imaging research areas, mainly in the field of \noncology, cardiology and neuropsychiatry, will impact the way medicine is \nperformed today. Both clinical and experimental multimodality studies, in \nhumans and animals, will have to demonstrate an efficient use of the imaging \ninformation provided by the modalities to affect the future of medical imaging. \nWe will comment on the impact of continued technological developments in \nmedical imaging on patients with cancer (diagnosis, staging and follow-up) and \n\nA B C D E F G S100  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nthe challenges of imaging technologies from research into clinical reality. The \nrecent advances and developments in measurements and biomarkers which \nhave led to a greater understanding of cancer will be commented, together with \nthe morphologic, metabolic and functional oncological imaging research and \nclinical practice. Finally, the role of the radiographer in advanced oncological \nimaging techniques will be evaluated.  \nLearning Objectives:\n1. To become familiar with advances and developments which have led to a \ngreater understanding of disease processes, improved monitoring and better \nclinical outcomes. \n2. To learn about state-of-the-art oncological imaging research and the steps \nrequired to make these techniques a clinical reality. \n3. To appreciate the role of the radiographer in advanced oncological imaging \ntechniques. \nA-452 14:51 \nC. Advanced cardiac imaging  \nM.L. Dijkshoorn; Rotterdam/NL \nIn the last 15 years cardiac CT imaging has developed from a high radiation \ndose research technique in a selected population into a low-dose clinical \nroutine examination. The CT scanners have made great advances in \napplicability, image quality and radiation dose reduction. But does this mean \nthat now we should provide every patient with potential coronary stenosis a \nCT-Angiography scan? Research on the topic of coronary CTA also has made \na development over time. At first the potential of the technique in limited \npopulations on single vendor scanners was investiged. Later larger multicenter \nstudies together with protocol optimization techniques were performed. Results \nhave led to guidelines on patient selection and technique suitability. All the \ntechnical developments in this field have led to a wide diversity of scan \nprotocols for different patients with the same clinical question. The role of the \nradiographer in this field is challenging because standard protocols are more \ndifficult to apply and more individual patient based protocol/parameter choices \nshould be made. Until now cardiac CT imaging has mainly focused on \nanatomic evaluation of the coronaries for calcium scoring and rule-out of \ncoronary stenosis. Just being able to provide nice images of the coronaries is \nnot enough for every patient. A lot of patients get additional functional exams \nlike SPECT or an exercise test. However, new functional CT imaging \ntechniques like CT-Perfusion and CT-FFR (Fractional Flow Reserve) are on \nthe horizon. Further research is in progress to clarify the potential and clinical \nposition of these new techniques. \nLearning Objectives:\n1. To become familiar with advances and developments in cardiac CT that \nhave led to a greater understanding of disease processes, earlier diagnosis, \nimproved monitoring and better clinical outcomes. \n2. To explore current state of the art cardiac CT imaging research and the \nsteps required to make these techniques a clinical reality. \n3. To appreciate the role of the radiographer in advanced cardiac CT imaging \ntechniques. \nAuthor Disclosure: \nM.L. Dijkshoorn: Consultant; Clinical training consultant Siemens Healthcare, \nThe Netherlands \nPanel discussion:  \nBridging the gap between research and clinical reality:  \na team approach  \n15:14\n14:00 - 15:30 Room P  \nSpecial Focus Session  \nSF 14c  \nDental imaging  \nA-453 14:00 \nChairman's introduction  \nJ. Fruehwald-Pallamar; Vienna/AT\n(julia.fruehwald-pallamar@meduniwien.ac.at) \nWhen imaging the head and neck region with CT or MRI, teeth are always \npresent. We frequently encounter radiolucent or radiopaque lesions of the jaw \non scans performed for other indications. Familiarity with typical dental \nconditions is necessary to subject the patients to the right therapy. To correctly \nevaluate and describe those lesions, this special focus session on dental \nimaging gives the radiologist a tool to report dental lesions. The anatomy of \npanoramic and CT images will be reviewed in the first talk. Technical details as \nwell as pitfalls will be presented. In the second talk, the focus is on pre- and \npost-surgical imaging with CT where typical lesions of the jaw will be \npresented. An insight into imaging the teeth with MRI will be given by the third \nspeaker. The discussion on the impact of radiologists on dental images will \ncomplement this special focus session's theme.  \nSession Objectives: \n1. To learn about the potential of cone-beam CT and MRI in dental imaging. \n2. To become familiar with maxillofacial anatomy. \n3. To understand postsurgical changes. \nA-454 14:05 \nReview of dentomaxillofacial anatomy with panoramic views and cone-\nbeam CT  \nA. Suomalainen; Helsinki/FI (anni.suomalainen@hus.fi) \nPanoramic radiography produces a single image of the maxilla, mandible, \nteeth, temporomandibular joints and maxillary sinuses. During the exposure, \nthe x-ray source and the detector rotate synchronously around the patient \nproducing a curved surface tomography. This horseshoe-shaped zone of sharp \nimage is called the focal trough/image layer. Advantages of this technique are \na good overview of lower facial hard tissues, the convenience of an extraoral \nexamination, a low patient radiation dose, and low costs. Disadvantages are \nlimited width of the sharply imaged layer, variable magnification, and oblique \nprojection, especially in the upper premolar region. Patient positioning is most \nimportant for obtaining a detailed panoramic radiograph. In addition to patient \nposition errors, patient movement during exposure and metal objects can \ncause artefacts. Also, ghost images caused by structures located between the \nx-ray source and the rotation centre can hamper diagnostics. CBCT is a \nradiographic imaging method that allows accurate 3D imaging of hard tissues. \nDuring a CBCT scan, the scanner rotates around the patient's head (180°-\n360°) obtaining multiple sequential planar projection images by a 2D detector. \nThe scanning software collects the data which is processed to create a \nvolumetric data set with isotopic voxels with varying FOV. Disadvantages of \nCBCT imaging are poor soft tissue contrast and artefacts. In addition to normal \npanoramic and CBCT anatomy, after this presentation the audience will be \nfamiliar with the panoramic and CBCT techniques as well as common errors \nand pitfalls of these techniques.  \nLearning Objectives:\n1. To learn about normal panoramic and cone-beam CT anatomy. \n2. To understand techniques of image acquisition. \n3. To become familiar with common errors and pitfalls. \nA-455 14:28 \nPre-surgical and post-surgical imaging with MDCT and cone-beam CT  \nA. Gahleitner; Vienna/AT (andre.gahleitner@meduniwien.ac.at) \nMultislice-CT and more recently cone-beam-CT have become an established \nmethod for anatomic imaging of the jaws prior to dental implant placement. \nCommonly referred to as \"dental-CT\", these high-resolution imaging \ntechniques have gained importance in diagnosing dental-associated diseases \nof the mandible and maxilla. Especially in patients with inflammations, cysts, \noro-antral fistulas, odontogenous sinusiti s, impacted teeth and dental fractures, \nnew indications have emerged. Unfortunately, most radiologists have had little \nexperience in this area and many of the dental-CT findings remain \nundescribed. Hence, we will determine the CT appearance of frequent dental-\nrelated diseases of the jaws and demonstrate typical pre- and postoperative \nfindings. This presentation reflects  our experiences from 18 years of \nperforming dental-CT with 36.000 investigations, closely working together with \ndentists and oral surgeons.  \nLearning Objectives:\n1. To learn about the typical findings from  pathological conditions of the jaw, \nwhich confront dentists and oral surgeons. \n2. To understand these findings in cross-sectional imaging like multislice and \ncone-beam CT. \n3. To learn about the usual treatments for these conditions in order to know \nhow they are used in dental radiology. \nA-456 14:51 \nDental MRI  \nS. Rohde; Dortmund/DE (stefan.rohde@klinikumdo.de) \nThis lecture will discuss the potential of dental MRI in the field of inflammatory \nand neoplastic disease of the periodontal space. Experimental and preliminary \nclinical data from high-field dental MRI will be presented with a special focus \non the visibility of critical anatomical structures on high-resolution sequences. \nThe results will be compared to high-resolution cone-beam CT.  \nLearning Objectives:\n1. To become familiar with the technical requirements. \n2. To learn about the advantages and disadvantages of dental MRI in \ncomparison to cone-beam-CT. \n3. To appreciate its potential and future prospective. \nPanel discussion:  \nWhat is the impact of radiologists in dental imaging?  \n15:14\n\nA B C D E F G S101  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n16:00 - 17:30 Room A  \nInteractive Teaching Session  \nE³ 1520  \nThoracic emergencies  \nA-457 16:00 \nA. Vascular  \nE. Castañer; Sabadell/ES (ecastaner@tauli.cat) \nBased on representative cases, we will review the main causes of thoracic \nnon-traumatic vascular emergencies (acute aortic syndrome, pulmonary \nthromboembolism and haemoptysis); MDCT angiography has become the first-\nline imaging test for the diagnosis of these entities. As acute aortic disease is \nthe most common fatal condition in patients with chest pain and prompt \nrecognition and treatment are of paramount importance, we will review the \nspectrum of acute aortic pathology focusing on the distinctive findings of each \nentity (classic dissection, intramural haem atoma and penetrating aortic ulcer) \nand upgrading the clues for their diagnosis. Acute pulmonary embolism (PE) \nremains a common clinical challenge. MDCT pulmonary angiography has \nbecome the first-line imaging study in the diagnosis of PE because of its \nspeed, accuracy, low interobserver variability and ability to provide alternative \ndiagnoses. We will review the role of MDCT in the evaluation of acute \nthrombotic PE: findings of acute PE (including how to evaluate the severity of \nan episode of PE at CT pulmonary angiography) and some potential pitfalls. \nMassive haemoptysis is a life-threatening condition that is associated with a \nhigh mortality rate. Haemoptysis usually involves bleeding from the bronchial \narteries or, less frequently, from nonbronchial systemic arteries. Haemoptysis \nof pulmonary arterial origin is rare, estimated at less than 10% of haemoptysis \ncases. MDCT angiography permits noninvasive, rapid, and accurate \nassessment of the cause and consequences of haemorrhage into the airways \nand helps guide subsequent management.  \nLearning Objectives:\n1. To become familiar with the main causes of thoracic vascular emergencies. \n2. To understand the role of MDCT angiography in thoracic emergencies. \n3. To learn about the radiological signs in vascular thoracic emergencies and \nits impact on the management of these patients. \nA-458 16:45 \nB. Pulmonary  \nC.M. Schaefer-Prokop; Amersfoort/NL (cornelia.schaeferprokop@gmail.com) \nAcute respiratory failure can have multiple underlying causes including \ninfection, fluid overload, immunological diseases or exacerbation of preexisting \nlung disease. Since the clinical symptoms are nonspecific, imaging plays an \nimportant role. The first imaging method is mostly the chest radiograph, easy to \naccess and to obtain, but non-diagnostic in many cases. (HR)CT offers more \npossibilities to define the differential diagnosis. The option of this interactive \nworkshop will be to get familiar with the spectrum of diseases that can cause \nacute respiratory failure and learn about key findings in radiography as well as \nCT to reduce the differential diagnosis. The interaction between preexisting \nlung disease, clinical information (e.g. chemotherapy, rheumatoid arthritis, \nCOPD) and imaging findings will be discussed using clinical case studies. \nOptions and also limitations of imaging findings will be illustrated. The following \nscenarios will be taken into account: acute cardiac failure and various \nappearances of oedema; acute immunological-toxic disorders including drug-\ninduced lung disease and inhalational injuries; exacerbations of preexisting \nlung disease including fibrotic and obst ructive lung disorders; severe infections \ncausing respiratory failure and their complications.  \nLearning Objectives:\n1. To learn about the role of imaging in severe attacks of obstructive lung \ndisease. \n2. To become familiar with direct and indirect signs of pleural disease causing \nrespiratory failure with special emphasis on the intensive care patient. \n3. To learn about imaging features which are helpful for the differential \ndiagnosis of pulmonary consolidations causing respiratory failure. \n4. To understand the interaction between comorbidity, age and extent of \npulmonary disease resulting in severe respiratory failure and the role of \nimaging in it. \n16:00 - 17:30 Room B  \nAbdominal Viscera  \nRC 1501  \nTechnical advances in liver and pancreatic \nimaging\nModerator:  \nD.J. Lomas; Cambridge/UK \nA-459 16:00 \nA. CEUS and elastography  \nG.H. Mostbeck; Vienna/AT (gerhard.mostbeck@wienkav.at) \nContrast-enhanced ultrasoud (CEUS) and elastography are evolving US \ntechniques that have already found their ways into clinical practice (CEUS) or \nwill do so in the next few years (elastography). CEUS is performed with 2\nnd-\ngeneration US contrast media, but these contrast media are not available \nworldwide. In many European countries, SonoVue® (Bracco, IT) is the only \navailable contrast, consisting of micro-bubbles less than the size of red blood \ncells. In contrast to CT and MR contrast media, these bubbles are strictly \nintravascular. For US imaging, low mechanical index US techniques are used \nto see the resonance of sound by these bubbles. CEUS is excellent for the \ndifferential diagnosis of focal liver lesi ons based on vascularisation and specific \ncontrast uptake (imaging the wash-in and wash-out of US contrast over time \nwith excellent temporal resolution) and increases US sensitivity to liver \nmetastases in colorectal cancer patients. However, CEUS is only useful when \nthere are excellent US conditions. In pancreatic US, CEUS allows to \ndifferentiate adenocarcinoma from neuroendocrine tumours based on \nvascularisation (US contrast uptake). Whereas elastography (strain \nelastography or shear wave elastography)  is established for the diagnosis of \nliver fibrosis, there are no general recommendations for using these various \ntechniques to measure the \"hardness of a focal lesion\" in focal liver and \npancreas lesions.  \nLearning Objectives:\n1. To become familiar with novel technical applications that are useful in liver \nand pancreatic diseases. \n2. To understand the underlying pathophysiologic processes. \n3. To learn about the strengths and limitations of CEUS compared with CT and \nMRI in the study of focal liver lesions and pancreatic diseases. \nA-460 16:30 \nB. Diffusion and perfusion  \nM.A. Bali; Brussels/BE (mbali@ulb.ac.be) \nDiffusion-weighted MR imaging (DW-MRI) provides information on tissue \ncellularity, extracellular space tortuosity and integrity of cell membranes by \nmeasuring the motion of water molecules in tissues modified by flows (blood \nvessels, glandular ducts,.). and interaction with cellular components. Integrated \nin conventional-MR acquisition protoco l, DW-MRI increases sensitivity for \nlesion detection. The apparent diffusion coefficient (ADC) can be calculated \nusing a mono-exponential relationship between signal attenuation and b-value. \nThis fitting is influenced by microcapillary perfusion. A more sophisticated \napproach (intravoxel incoherent motion, IVIM) would enable estimation of \nparameters that separately reflect tissue diffusivity and microcapillary \nperfusion. Using IVIM-analysis, the derived quantitative parameters describe \ntissue diffusivity, perfusion and perfusion fracti on. By providing qualitative and \nquantitative information, DW-MRI is applied in oncology to characterise \nmalignancy, including lesion aggressiveness, and to monitor treatment \nresponse. Perfusion imaging is a useful tool to achieve information concerning \ntissue vasculature, microvascular permeability and interstitial space \ncharacteristics. Dynamic contrast-enhanced techniques (DCE-CT, DCE-MR) \nare based on the analysis of the contrast agent (tracer) biodistribution in \ntissues. Quantitative parameters are obtained using pharmacokinetic models, \nas transfer constant Ktrans, extracellular-extravascular space fraction ve, \nvascular tissue fraction vp and the rate constant Kep. Quantitative DW-MR and \nDCE-MR parameters are increasingly used as imaging biomarkers to predict \ntumour response and/or to monitor the effects of therapy, especially when anti-\ncancer agents with novel models of action are used (anti-angiogenic, tyrosine \nkinase inhibitors and several others). Therefore, these new imaging biomarkers \nmay have a pivotal role in correctly evaluating tumour response and stratify \nand managing cancer patients.  \nLearning Objectives:\n1. To learn about the technical requirements necessary for diffusion-weighted \nMRI and how to avoid artefacts. \n2. To learn about the technical requirements for CT and MRI perfusion. \n3. To become familiar with imaging biomarkers useful in tumour evaluation. \n\nA B C D E F G S102  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-461 17:00 \nC. Liver specific contrast agents  \nB.J. Op de Beeck; Antwerp/BE (bart.op.de.beeck@uza.be) \nFor state-of-the-art MR liver and pancreatic imaging, a field strength of at least \n1.5T is required. All non-blood pool gadolinium chelate-based contrast agents \nare suitable for dynamic liver and pancreatic MRI. All gadolinium chelates \nshould be routinely administered at a rate of 1-2 ml/s followed by a 20 ml saline \nflush at 1-2 ml/s using a power injector. To obtain hepatobiliary phase imaging \nin addition to dynamic phase imaging, the use of liver-specific contrast agents \nis required. Gd-EOB provides the highest hepatocyte enhancement, but an \noverlap between delayed phase and hepatocyte phase has to be considered \nduring dynamic evaluation. The hepatocyte phase can be considered adequate \nwhen contrast is detected in the intrahepatic bile ducts. Hepatobiliary phase \nimaging benefits from a gradient echo high flip angle, depending on magnet \nfield strength. In the absence of liver function impairment and biliary \nobstruction, contrast-enhanced MR cholangiography can be obtained with Gd-\nEOB at 20-40 minutes, and with Gd-BOPTA at 60-120 minutes. When the \ndifferential diagnosis is pri marily between solid benign lesion vs. metastasis, \nthe use of a liver-specific CA is recommended, due to the ability to diagnose \nFNH confidently. The combined interpretation of dynamic and hepatobiliary \nphase improves diagnostic accuracy of MR imaging for the detection of HCC. \nHemangiomas and intrahepatic CCC result in relative hypointensity in the late \nvascular phase after Gd-EOB administration. When combined with T2-\nweighted MRCP, contrast-enhanced MRC allows morphologic and functional \nassessment of the biliary system.  \nLearning Objectives:\n1. To learn about the principals and recent technical advances in the use of \nliver specific contrast agents for liver imaging. \n2. To appreciate the similarities and differences between the classes of \ncontrast agent. \n3. To become familiar with indications of liver specific contrast in biliary \ndiseases. \n4. To learn about future directions of MRI contrast agents. \n16:00 - 17:30 Room C  \nModern Imaging of the GI Tract  \nCC 1521  \nGastrointestinal stromal tumours (GIST)  \nModerator:  \nM. Zins; Paris/FR \nA-462 16:00 \nA. Pathology and treatment options  \nB. Seddon; London/UK (beatrice.seddon@uclh.nhs.uk) \nGastrointestinal stromal tumours (GIST)  are rare malignant tumours arising \nwithin the wall of the gut from the interstitial cells of Cajal, which act as \npacemaker cells controlling peristalsis. The crude annual incidence of clinically \ndetected GISTs is approximately 10 cases per million in Europe. The median \nage at diagnosis is approximately 63 years, and 80% of patients are older than \n50 years. However, a small number of cases do occur in younger people and \nchildren, and these are usually syndromic GISTs. GISTs can occur at any site \nof the gut from the oesophagus to rectum, although they can also arise in the \nextra-gastrointestinal abdominal and pelvic locations, so-called e-GISTs. The \ncommonest location is the stomach (55%), followed by the small intestine \n(35%) and rectum (5%). Diagnosis is by biopsy, with spindle cell or epithelioid \nmorphology, and immunohistochemical stai ning for CD117 (the protein product \nof the KIT gene) and/or DOG-1 receptors. Approximately, 80% of GISTs have \nmutations in the KIT gene, 10% have mutations of the PDGFRA gene, and the \nremaining 10% have no mutation (wild-type) or rare gene mutations. Early \nstage disease is managed by surgery, followed by 3 years of adjuvant imatinib \n(a tyrosine kinase inhibitor with activity against KIT and PDGFRA receptors) for \ncases at high risk of relapse. Advanced metastatic disease is treated with \nimatinib, with a median duration of response of approximately 2 years. At \ndisease progression, second-line treatment is with sunitinib, with a median \nduration of response of approximately 6 months.  \nLearning Objectives:\n1. To learn about the prevalence and typical location of GIST tumours. \n2. To understand the histological and g enetic characteristics of GIST tumours \nand the differential diagnosis. \n3. To become familiar with the treatment options for GIST tumours. \nAuthor Disclosure:\n B. Seddon: Author; Author on paper on sunitinib in GIST. \nA-463 16:20 \nB. Disease staging and treatment planning  \nC. Hoeffel; Reims/FR (choeffel-fornes@chu-reims.fr) \nImaging plays a major role in the detection, characterisation and staging of \ngastrointestinal tumours (GISTs). Imaging of GISTs depends on the mode of \npresentation and the local availability. Endoscopic ultrasound and computed \ntomography (CT) are the most widely used imaging methods. GISTs have a \nspectrum of radiological appearances depending on tumour size and site of \norigin, but often show certain key radiological features. Multiphase \nmultidetector row CT is necessary to detect and stage GISTs and multiplanar \nimaging is important so as to define the likely organ of origin of the mass, \nwhich may be a challenging task. The clinical diagnosis of a GIST is based \nmainly on imaging, as biopsy runs the risk of tumour rupture or seeding of the \nbiopsy tract. In patients with an unresectable primary tumour or metastatic \ndisease at presentation, biopsy confirmation is important before starting \nmedical treatment. CT or/and MRI are used to assess primary tumour \nextension, local invasion and the presence of metastases, with main sites of \nmetastasis being the liver and the omentum.  \nLearning Objectives:\n1. To appreciate the imaging modalities available for staging GIST tumours, \nand to understand the advantages and disadvantage of each. \n2. To learn about optimised acquisition protocols. \n3. To become familiar with the imaging differential diagnosis of GIST tumours \nand the role of biopsy. \n4. To appreciate the radiological staging of GIST tumours, including typical \nsites of metastatic disease. \nA-464 16:40 \nC. Treatment response assessment and disease follow-up  \nA. Graser; Munich/DE (Anno.Graser@med.uni-muenchen.de) \nGastrointestinal stromal tumours (GISTs) are treated with targeted therapy \nregimes. These treatment strategies are based on the suppression of tumour \nvasculature using the tyrosine kinase inhibition pathway. Drugs like imatinib \nand sunitinib exhibit specific changes in tumours and metastases that can be \ndetected on cross-sectional imaging. These changes differ significantly from \nstandard treatment effects of cytotoxic chemotherapy. While the latter leads to \ndestruction of tumour cells and thereby to a reduction of tumour size, the \nformer will cause a decrease in vascularity and thereby in attenuation and \nenhancement of lesions while the size may remain unchanged. Radiologists \nhave to be aware of these specific patterns of response to treatment. This \npresentation will include a review of the Choi criteria which have been \ndeveloped for the assessment of GIST lesions under treatment. Also, current \nimaging strategies focusing on time-resolved CT imaging (CT perfusion \nimaging) will be presented. The aim of this lecture is to provide a practical \napproach to response imaging in GIST patients integrating both existing and \nnovel strategies.  \nLearning Objectives:\n1. To understand the role of imaging in disease treatment response \nassessment and the pros and cons of available modalities. \n2. To appreciate the imaging criteria used in the assessment of disease \nresponse. \n3. To learn how imaging can help guide appropriate therapy. \nAuthor Disclosure:\n A. Graser: Grant Recipient; Bayer Healthcare, Siemens Healthcare. \nResearch/Grant Support; Bayer Healthcare, Siemens Healthcare. Speaker; \nSiemens Healthcare, Bracco Diagnostics, Pfizer Pharma, GlaxoSmithKline. \nA-465 17:00 \nD. Interactive case discussion  \nM. Zins; Paris/FR \n16:00 - 17:30 Room D  \nCardiac  \nRC 1503  \nCardiac CT and MRI in difficult patients: \nwhat to do?  \nA-466 16:00 \nChairman's introduction  \nM. Hamilton; Bristol/UK (Mark.Hamilton@UHBristol.nhs.uk) \nPerforming high-quality examinations is easy in the ideal patient. However, \nmany subjects present challenges that if not overcome may lead to a failed \nexamination. For example, the obese, the breathless, the arrhythmic, the \n\nA B C D E F G S103  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nelderly and the young can all present special problems that require a greater \ndepth of understanding to obtain a diagnostic study. This session will help you \nin your quest for reliable high-quality investigations for all.  \nA-467 16:05 \nA. Coronary CTA in patients with severe arrhythmias and high heart rate  \nC. Loewe; Vienna/AT (christian.loewe@meduniwien.ac.at) \nBesides all advances in scanner technology, heart rate remains a critical issue \nfor coronary CTA, and motion artefacts due to cardiac function represents still \nthe most frequent reason for limited diagnostic image quality in cardiac CTA. \nThus, the target heart rate is defined depending on the scanner system used \nand ranged between below 60 bpm and below 70 bpm. However, in a number \nof patients heart rate control is not possible or not successful (i.e. children, \nemergencies, heart transplant recipients), whereas a relevant proportion of \nCTAs are performed in patients with heart rates higher than the target \nfrequency. During this presentation, the possibilities for heart rate control by \nbeta blocker injection and beyond will be discussed and possible workflows will \nbe presented. Furthermore, examination strategies for patients with high heart \nrates will be presented including reverse dose modulation, high-pitch scanning, \nsystolic scanning and more. Finally, tools for reconstruction and assessment of \npatients scanned at higher heart rate will be introduced. Different to high heart \nrates and even more critical with regard to image quality is arrhythmia. Due to \nthe complexity of cardiac synchronisation, a CT suite is not the place for \ncardiac resynchronisation, whereas the indication to CTA has to be \nreevaluated depending on referring diagnosis and severity of arrhythmia. Since \nthere are patients undergoing CTA because of arrhythmia including patients \nprior to ablation treatment, strategies for examination and image reconstruction \nin case of arrhythmic patients have to be established and will be presented.  \nLearning Objectives:\n1. To understand the criteria for optimal patient selection and preparation to \nachieve best results. \n2. To learn about acquisition techniques in patients with arrhythmias and \ntachycardia. \n3. To become familiar with the post-processing techniques available for \noptimising image quality following the scan. \nA-468 16:28 \nB. Severe coronary calcinosis and stents: tips and tricks in image \nacquisition and interpretation  \nF. Pugliese; London/UK (francesca.pugliese@libero.it) \nCardiac computed tomography (CT) has become a widely available diagnostic \ntool used in a range of heart conditions. The commonest application of this \ntechnique is in the evaluation for coronary artery patency (coronary CT \nangiography) in patients with chest pain. When coronary arteries are heavily \ncalcified, or post-coronary angioplasty with stent implantation, diagnostic \nproblems can occur. In these circumstances, the evaluation of the coronary \narteries on CT is hampered by the occurrence of high-density artefacts caused \nby calcifications and stent struts. These artefacts may preclude the appropriate \nassessment of the coronary lumen. The presence of motion artefacts in the \ndataset or image noise in very large patients may exacerbate the problem. In \nthis scenario, accurate patient selection and preparation remain key to ensure \nthat the diagnostic yield of the cardiac CT study is good. Optimisation of scan \nparameters (kV), contrast injection protocol and use of appropriate post-\nprocessing techniques (e.g. dedicated convolution filters) play an important \nrole in daily clinical practice. Recent technical developments include dual-\nenergy scan techniques and gemstone spectral detector systems that acquire \nsimultaneously high and low kilovoltage datasets. This is done to achieve \ntissue differentiation. In principle, by using monochromatic image \nreconstruction, the effect of high-density artefacts may be decreased. Using a \nsimilar principle, high-density structures can be subtracted from the image. The \nintroduction of iterative reconstruction algorithms may play a role in that these \nalgorithms are theoretically more accurate in the modeling of physical noise \nand tissue geometries.  \nLearning Objectives:\n1. To understand the challenge of calcification and stents when performing \ncoronary CTA. \n2. To become familiar with technical features that maximise image quality in \nthis patient group. \n3. To be aware of the accuracy of coronary CTA in stented or calcified vessels \nwith the optimum imaging techniques. \nA-469 16:51 \nC. Cardiac MRI: potential problems and how to avoid them  \nE. Mershina; Moscow/RU (elena_mershina@mail.ru) \nLack of movement artefacts is one of the major prerequisites for good image \nquality in cardiac MR. It is crucial  to have the minimum possible image \nacquisition time. It is important to make both TE and TR as short as possible. \nData acquisition should be synchronised with patient's ECG or pulse. Special \nattention should be paid to good quality of ECG recordings (good contact of \nelectrodes with the skin, electrodes posi tioning, using of dielectric pad). In \npatients with arrhythmia, prospective ECG synchronisation should be used \ninstead or a retrospective one, or special protocols may be applied for \narrhythmia correction. Breathing artefacts are usually not a problem for cardiac \nMRI, because most sequences are acquired during a single breath-hold. Using \nSSFP and parallel imaging allows obtaining a complete set of cine MR images \nthrough the whole heart in 1-8 short breath-hold periods. The technique of real-\ntime cardiac MR is a good way to perform successful examinations even in \ndifficult patients, especially the ones with heart failure. Other systemic MR-\nartefacts (aliasing, chemical shift, magnetic susceptibility, off-resonance) \nshould be recognised and diminished or eliminated by the operator. These \nartefacts are more prominent in case of 3 T systems. Late-enhancement \nstudies with Gd are very dependent on the correct selection of the TI time. \nPhase-contrast MRI requires VENC calibration in cases of valve stenoses. To \nmeet the challenges and the benefits of cardiac MRI, one must balance the \nconstraints of signal- and contrast-to-noise ratios, spatial and temporal \nresolution, scan time and image quality.  \nLearning Objectives:\n1. To learn about the importance of patient selection and preparation in \nachieving high-quality scans. \n2. To understand the practical techniques available for performing a successful \nscan in difficult patients such as those with arrhythmia or poor breath-holding \nability. \n3. To learn how imaging parameters can be changed for optimal results. \nPanel discussion:  \nWhen to scan and when not to?  \nHow can we make the best of what we have?  \n17:14\n16:00 - 17:30 Board Room B  \nPaediatric  \nRC 1512  \nPaediatric MSK radiology: what is \nimportant?\nModerator:  \nR.A.J. Nievelstein; Utrecht/NL \nA-470 16:00 \nA. Scoliosis: what the radiologist needs to know  \nA. Geoffray, J.-L. Clément; Nice/FR (a.geoffray@lenval.com) \nScoliosis, a common spinal deformity in teenagers, especially girls, progresses \nduring their growth until the end of puberty. Therapeutic choices, which are \neither medical - with corset - or surgical, depend on this progression. Follow-up \nis mainly clinical. However, radiographs are often indicated to give precise \ninformation: AP and lateral views of th e spine in standing position remain the \nbasis of this follow-up. Obtaining a good image quality at all levels of the spine \nhas been a technical challenge for a long time, and the question of radiation \ndose is also a main concern, as these radiographs require a high radiation \ndose. Fortunately, radiographic techniques have greatly improved over the \npast few years: From the conventional 90 or 120 cm film to digital screens and \nnow flat screens, we now obtain better quality images with less radiation. \nToday, EOS system using Xenon chamber is the best to give good AP and \nlateral views. It allows 3D reconstructions with minimal radiation dose. On \nthese radiographs, measures can be performed, essentially Cobb's angle. It \nhelps in evaluating progression of t he curves and making surgical decisions. \nOther imaging techniques are requested only in particular situations as in the \npresence of neurological symptoms or general disease such as \nneurofibromatosis, or in young children with malformative scoliosis and \nsometimes preoperatively. CT is best to study the vertebrae; it objectivates \nvertebral malformations (agenesis, hypoplasia, blocks). MR will be requested \nto study the cord, nervous roots, craniospinal junction and the soft tissues. \nCollaboration between the radiologist and spinal surgeon is essential.  \nLearning Objectives:\n1. To understand how to balance the need for information on the progression \nof scoliosis against the exposure to ionising radiation. \n2. To become familiar with the essential measurements in the scoliotic spine, \ntheir reliability and validity. \n3. To understand the role of the radiologist in scoliosis imaging. \nA-471 16:30 \nB. Benign bone tumours and pseudotumours in children: the pitfalls  \nD. Dumitriu; Brussels/BE (dana.dumitriu@uclouvain.be) \nBenign bone lesions in children are commonly an incidental radiographic \nfinding. They may also cause pain, a pa lpable mass or pathological fracture. It \n\nA B C D E F G S104  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nis the radiologist's role to follow a di agnostic algorithm helping him decide on \nthe following points: Is the lesion a tumour or not? Is a normal variant \nexcluded? If it is a tumour, does it show signs of malignancy? Is the \nradiological aspect typical for a \"don't touch lesion\" or are other investigations \nnecessary? The key elements in the diagnostic process, as for most bone \nlesions, are: the age of the patient, the type of bone and bone segment \ninvolved, the location within the bone, the presence of signs of aggressiveness \n(type of osteolysis, limits, presence and type of periosteal reaction). \nConventional x-rays should never be absent from the initial workup of a focal \nbone lesion in a child, as they provide essential features for differential \ndiagnosis and, in most cases, eliminate the need for other more costly \ntechniques. The need and priority for other imaging techniques, such as CT, \nMRI and bone scintigraphy, are decided on a case-by-case basis and \nsometimes a combination of these techniques, which complement each other, \nis needed. It is the radiologist's responsibility to recommend histological \nanalysis of a lesion via biopsy whenever the imaging aspect is not \ncharacteristic or indicates signs of possible malignancy.  \nLearning Objectives:\n1. To recognise the most common benign bone tumours and pseudo-tumours. \n2. To understand the differences between benign bone tumours, pseudo-\ntumours and malignancies in children. \n3. To understand imaging modalities that could help in the differential diagnosis \nof benign bone tumours and pseudo-tumours in children. \nA-472 17:00 \nC. Congenital bone dysplasias  \nA.C. Offiah; Sheffield/UK (amaka.offiah@nhs.net) \nThe 2010 Nosology and Classification of Genetic Skeletal Disorders subdivides \n456 conditions into 40 groups defined by molecular, biochemical and/or \nradiographic criteria. 316 conditions are associated with mutations in at least \none of 226 different genes. Some of these conditions are rare or even \nextremely rare (occurring in fewer than 1 in 100,000 of the population). Clearly, \nthe general paediatric radiologist cannot be expected to correctly recognise \nand diagnose all of these conditions. The approach is to perform a set of \nradiographic images dependent on the patient's age/size and to develop a \nstandard system for reviewing these images. The standard set of images for a \npatient over 2 to 3 years of age consists of AP and lateral skull, AP chest, AP \npelvis, lateral thoracolumbar spine, AP one upper limb, AP one lower limb and \nDP left hand. Variations on this routine dysplasia skeletal survey will be \ndiscussed and a standard system for interpreting the images will be presented \nusing radiographs of the commoner skeletal dysplasias as examples.  \nLearning Objectives:\n1. To understand the role of the radiologist in diagnosing congenital bone \ndysplasias. \n2. To understand how to classify bone dysplasias. \n3. To learn how to report radiological studies related to bone dysplasias. \nAuthor Disclosure:\n A.C. Offiah: Advisory Board; BioMarin - Management of Spinal Cord \nCompression in Patients with MPS IVA. Author; Fetal and Neonatal Skeletal \nDysplasias (Published by Radcliffe Ltd). Speaker; Over the past 10 years I \nhave given multiple lectures in relation to the imaging of skeletal dysplasias. \nOther; I am Chairperson of the Skeletal Dysplasia Group for Teaching and \nResearch. \n16:00 - 17:30 Room E1  \nSpecial Focus Session  \nSF 15a  \nBody composition: a new string to the \nradiologist's bow  \nA-473 16:00 \nChairman's introduction  \nG. Guglielmi; Foggia/IT (giuseppe.guglielmi@unifg.it) \nIn the last few years, interest in body composition (BC) analysis, which is the \nquantification and characterisation of relative amounts of muscle, fat, bone, \nand other vital parts composing the human body, has grown rapidly for clinical, \nresearch and epidemiological purposes. Studying body composition has \ngained great importance for the comprehension and decoding of a multitude of \npatho-physiological processes (e.g. obesity, diabetes and endocrine diseases \nand also gastrointestinal, renal, nervous, infectious diseases, etc). and \nphysiological and para-physiological co nditions as in athletes or growth and \nageing processes. Although the main imaging techniques, which include dual-\nenergy x-ray absorptiometry (DEXA), computed tomography (CT), and \nmagnetic resonance imaging (MRI), offer a differentiated and attractive \nanalysis of BC, they still need to find a definite position in clinical practice.  \nSession Objectives: \n1. To become familiar with abnormalities involving fat mass, lean mass and \nbone. \n2. To understand the importance of body composition for clinical purposes, \nresearch purposes and epidemiological purposes. \n3. To learn about the predictive value of body composition variables. \nA-474 16:05 \nBody composition: why and how?  \nJ.E. Adams; Manchester/UK (judith.adams@manchester.ac.uk) \nThrough 'programming' low birth weight is associated with increased rates of \ncoronary heart disease, stroke, hypertension & non-insulin dependent \ndiabetes. Prediction of morbidity and mortality from body composition, \nparticularly fat, stimulates the importance and application of accurate and \nprecise methods for quantitative assessment of body composition; the gold \nstandard for which is cadaver analysis, but other methods have to be \nimplemented in vivo. Body composition alters in many chronic diseases, \nstarvation cases, metabolic syndromes, and senescence stages, and is a key \ncomponent of health. Several techniques are available which vary in simplicity \nand complexity of use. Each make assumptions and may not measure body \ncomposition directly, but make predictions from other measurements made. \nSkinfold thickness measurements assess regi onal fat and are quick and simple \nto perform at all ages. Reproducibility is good, but less so in obesity. There is \nsome limitation of reference data to express results as standard deviation \nscores (SDS). Body mass index (BMI; weight/height\n2) is widely used as an \nindex of relative weight expressed as SDS for gender, age and ethnicity. Waist \ncircumference (WC) is a measure of central fat, and can also be expressed as \na ratio to hip circumference. Bioelectric impedance analysis (BIA) measures \nbody impedance to a small electric current, which estimates total body water \n(TBW) from which can be derived fat free mass (FFM). TBW can also be \nmeasured by neutron activation. Air displacement plethysmography (Bod Pod) \nis a new method for body composition assessment.  \nLearning Objectives:\n1. To understand normal body composition in children and adults. \n2. To learn how body composition can be altered by disease. \n3. To appreciate the clinical relevance of assessing body composition. \n4. To understand the non-imaging methods available for measuring body \ncomposition, with their advantages and limitations. \nA-475 16:25 \nComputed tomography: what does it measure and how?  \nJ. Damilakis; Iraklion/GR (damilaki@med.uoc.gr) \nCT allows measurement of total body fat and enables differentiation of \nsubcutaneous from visceral adipose tissue. Body fat can be estimated using \nthe conventional technique of manual plani metry. Using planimetry, the user \ndelineates manually the boundaries of subcutaneous and visceral fat in each \nCT image. However, this method is labour intensive, time-consuming, and, \ntherefore, not easily applicable in routine clinical practice. Another CT method \nused for the estimation of abdominal fat is the semiautomatic measurement of \nadipose tissue area. Abdominal fat is assessed in a CT slice by using a fixed \nrange of Hounsfield units to define the area of adipose tissue. A limitation of \nthis method is that the attenuation range of fat may vary among individuals. \nThe stereological volume estimation method is based on the Cavalieri's \nprinciple. According to this principle, the volume of an object can be measured \nby cutting it into equally spaced slices and measuring the area of the object on \neach slice. To measure body fat using stereology, a square grid of test points \nis randomly superimposed on each CT section. All points lying inside the fat \ntissue region are selected by the user and the software automatically \ncalculates the total number of points hitting the fat. Stereology provides the \npossibility for efficient fat volume assessment. However, research studies are \nneeded to optimise the stereological estimation of fat and compare \nstereological measurements with those from other adipose tissue \nmeasurement CT techniques.  \nLearning Objectives:\n1. To appreciate the role of CT imaging in body composition analysis. \n2. To learn how to measure visceral and subcutaneous adipose tissue using \nCT. \n3. To understand the advantages and limitations of CT techniques (planimetry, \nthresholding, stereology) in evaluating adipose tissue. \nA-476 16:40 \nMRI: current and future applications  \nD.C. Karampinos; Munich/DE (dimitrios.karampinos@tum.de) \nMRI has been emerging as an ionising radiation-free imaging modality to \nmeasure fat distribution in the human body and fat content in different organs. \nThe present talk will first introduce MRI methods to measure fat distribution, \n\nA B C D E F G S105  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nincluding the well-established T1-weighted imaging and the emerging Dixon \nimaging approaches. The challenges related to the data acquisition and image \npost-processing of the two imaging approaches in the study of fat distribution \nwill be reviewed. Examples will be shown from the current use of MRI in \ninvestigating adipose tissue distribution al terations or differences in patients \nwith metabolic disorders, including o besity and diabetes. Quantitative MRI \nmethods enabling the measurement of fat content with high spatial resolution \nwill be then presented, with a focus on water-fat separation methods. The \ntechnical challenges associated with the establishment of MRI-based fat \ncontent, as an accurate and reproducible imaging biomarker will be discussed. \nThe selection of pulse sequence parameters and image reconstruction \nalgorithm in a state-of-the-art water-fat separation experiment will be \nexplained. Applications will be shown from the growing literature of MRI-based \nfat quantification in abdominal organs  (e.g. liver) and in skeletal muscles, \naiming to show the great premise of quantitative water-fat MRI in quantifying \nfat content with high spatial resolution in different body parts. At the end of the \ntalk, the potential of quantitative water-fat MRI will be discussed in the \nemerging application of measuring bone marrow fat content and its association \nwith bone health and metabolic disorders.  \nLearning Objectives:\n1. To become familiar with MRI techniques for measuring fat content and fat \ncomposition. \n2. To learn about the current use of MRI in measuring adipose tissue \ndistribution in metabolic disorders. \n3. To learn about the potential of MRI for measuring bone marrow fat content in \nosteoporosis. \nAuthor Disclosure:\n D.C. Karampinos: Research/Grant Support; Philips Healthcare. \nA-477 16:55 \nDXA: technical aspects and application  \nA. Bazzocchi; Bologna/IT (abazzo@inwind.it) \nThe key role of dual-energy x-ray absorptiometry (DXA) in the management of \nmetabolic bone diseases is well known. The role of DXA in the study of body \ncomposition and in the clinical evaluation of disorders which directly or \nindirectly involve the whole metabolism as they may induce changes in body \nmass and fat percentage is less known or less understood. DXA has a range of \nclinical applications in this field, from assessing associations between adipose \nor lean mass and the risk of disease to understanding and measuring the \neffects of pathophysiological processes or therapeutic interventions, in both \nadult and paediatric human populations as well as in pre-clinical settings. DXA \nanalyses body composition at the molecular  level that is basically translated \ninto a clinical model made up of fat mass, non-bone lean mass, and bone \nmineral content. DXA allows total and regional assessment of the three above-\nmentioned compartments, usually by a whole body scan. Since body \ncomposition is a hot topic today, manufacturers have steered the development \nof DXA technology and methodology towards this. New DXA machines have \nbeen designed to accommodate heavier and larger patients and to scan wider \nareas. New strategies, such as half-body assessment, permit accurate body \nscan and analysis of individuals exceed ing scan field limits. Although DXA is a \nprojective imaging technique, new solutions have recently allowed the \ndifferential estimate of subcutaneous an d intra-abdominal visceral fat. The \ntransition to narrow fan-beam densitometers has led to faster scan times and \nbetter resolution; however, inter- or intr a-device variation exists depending on \nseveral factors.  \nLearning Objectives:\n1. To appreciate the role of DXA in the study of body composition. \n2. To understand potential limitations and pitfalls of DXA in the analysis of body \ncomposition. \n3. To learn about technical elements and methods, and to become familiar with \nbiomarkers in DXA. \nPanel discussion:  \nHow to rationalise the use of body composition analysis in radiological \npractice  \n17:15\n16:00 - 17:30 Room E2  \nState of the Art Symposium  \nSA 15  \nTumour response assessment in clinical \npractice  \nA-478 16:00 \nChairman's introduction  \nE. De Kerviler; Paris/FR (eric.de-kerviler@sls.aphp.fr) \nIn cancer patients, disease-free survival  is a good indicator for tumour \nresponse, but for many common cancers, treatment of disseminated disease is \noften noncurative. The increased duration of survival is related to changes in \ntumour size after treatment. However, the anatomical determination of tumour \nresponse has some limitations, especially when non-cytotoxic targeted \ntherapies are used. With these new treatments options, the lack of progression \nmay be associated with a good improvement in outcome, even in the absence \nof major shrinkage of tumours. New imaging biomarkers are therefore needed \nto assess therapeutic response. Molecular imaging is now playing a prominent \nrole in the monitoring of cytostatic targeted therapies. PET-CT, dynamic \ncontrast enhancement studies or diffusion-weighted imaging are the most \npromising ones. The aim of this session is to present the state of the art in \ntumour response assessment with regard to new therapeutic regimens.  \nSession Objectives: \n1. To understand the role of the radiologist in cancer patient management. \n2. To appreciate the key issues of tumour assessment in oncology. \n3. To become familiar with the most common response criteria used in practice \nand in clinical trials. \n4. To learn about future imaging biomarkers in response assessment. \nA-479 16:05 \nEndpoints for therapy response assessment: the oncologist's \nperspective  \nJ. Carles; Barcelona/ES (jcarles@vhio.net) \nIn early oncologic times, treatments of different malignancies were reported in \ndifferent ways. C. Gordon Zubrod and others first articulated the model of \nmulticentre clinical trials and argued for standards to be agreed for included \nand excluded subjects, the method of assigning treatment and in measuring \nresponse. Nowadays, we have better knowledge of tumour biology; however, \nwe continue using the classical response criteria (WHO and RECIST) and \noverall survival as a primary goal for effective treatment in most of the \nmalignancies. In the last few years, different criteria for responses have been \nreported to evaluate the disease and a lot of discussions between authors \nhave been reported. Now, we can use the RECIST criteria v1.1, implement the \nPERCIST criteria and also forget the IMMUNOTHERAPY criteria. Furthermore \nin the last few years, different treatments such as vaccines, antiangiogenics \nand targeted therapies have increased our arsenal in the treatment of different \nmalignancies such as kidney cancer, prostate cancer, breast cancer and so on. \nAnother problem for our patients is that those diseases have a long evolution \nafter the first-line treatment. We have to be able to define in each disease the \ntreatment line and type of treatment to determine which evaluation criteria are \nnecessary and which is the objective of treatment, PFS or OS. We have to be \naware that if we are not able to define such topics, we may be losing active \ntreatments.  \nLearning Objectives:\n1. To learn about prognostic implications in survival. \n2. To understand new endpoints in targeted therapies. \n3. To appreciate differences between chemotherapies and targeted therapies. \nA-480 16:23 \nRevised RECIST guidelines: principles, practical applications and pitfalls  \nL.S. Fournier; Paris/FR (laure.fournier@egp.aphp.fr) \nRECIST 1.1 are the criteria most often used in studies to evaluate response to \ntreatment in solid tumors. On each follow-up examination, response is defined \nby a combination of unidimensional measurement of 'target lesions', qualitative \nevaluation of 'non-target' lesions, and presence/absence of 'new lesions'. CT \nand MRI are the preferred modalities for RECIST evaluation, and evaluations \nmust be performed using the same modality, in the same plane. We will review \nanatomic locations which should be avoided, and how to deal with intercurrent \nevents resulting in the impossibility of measurement. Cases when RECIST \nseems inadequate will be discussed, including evaluation of bone metastases, \nand focal therapy. Finally, though these criteria were developed for drug trials, \nthey may provide a frame for reading examinations and writing reports in \nroutine practice. Reproducible, objective and quantitative criteria help to define \n\nA B C D E F G S106  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\na common language between radiologists and clinicians, so that the latter can \nmake an informed treatment decision based on sound conclusions.  \nLearning Objectives:\n1. To learn about the RECIST 1.1 criteria. \n2. To become familiar with the conditions necessary to implement them. \n3. To understand the limits of their application. \n4. To learn useful lessons from these criteria for routine clinical practice. \nAuthor Disclosure:\n L.S. Fournier: Author; Pfizer, Merck. Speaker; Pfizer. \nA-481 16:41 \nCriteria beyond RECIST: Choi, mRECIST, EASL-AASLD, PERCIST  \nS. Gwyther; Redhill/UK (GwytherSJ@aol.com) \nRadiological response evaluation using anatomical imaging was developed in \nthe 1980s in early Phase II clinical trials. Potential new anti-cancer agents were \nassessed by measuring tumour size before and during therapy and a pre-\ndetermined reduction in size constituted response. Radiological response \nrepresents an objective surrogate for patient benefit and was the primary end \npoint in early Phase II studies. If a pre-defined percentage of patients achieved \nthe required response, then the agent proceeded to large Phase II and III \nstudies where clinical time to progression or progression-free survival \ncomprised the primary end point. Between 1980 and 2000, there were \nextraordinary advances in cross-sectional imaging techniques which became \nwidely available. Different imaging techniques were introduced piecemeal with \ndifferent co-operative groups adding different requirements, so meaningful \ncomparisons from one trial to another could not be made. In 2000, the RECIST \ncriteria were introduced requiring specific imaging stipulations and a minimum \nbaseline tumour size to unify the different criteria and enable meaningful \ncomparisons from one study to another. Further advances continue to be made \nregarding anatomical and functional imaging. Not all anti-cancer agents are \ncytocidal and many studies now use time to progression or progression-free \nsurvival defined by radiological imaging as the primary end point. Certain \ntumour types respond in a unique manner requiring the employment of specific \nresponse criteria in these tumour types to adequately demonstrate response. \nSome of these tumour types and their specific response criteria will be \ndiscussed.  \nLearning Objectives:\n1. To learn about the role of radiological response evaluation in clinical trials. \n2. To understand how radiological response evaluation has evolved and \ncontinues to evolve. \n3. To understand which response criteria are utilised in specific tumour types. \nA-482 16:59 \nEmerging biomarkers for response assessment: pros and cons  \nM.C. Roethke; Heidelberg/DE (m.roethke@dkfz.de) \nNon-invasive response assessment of new specific anti-cancer therapies is an \nemerging field of oncologic imaging. In the past few years, large efforts were \nundertaken to develop new functional biomarkers to enable an earlier \ndiagnosis, improved risk stratification and treatment monitoring of oncological \ndiseases. Imaging biomarkers reflect changes in tumour biology, which can be \ndifferentiated into certain categories (e.g. cell density, tumour heterogeneity, \niron concentration, elastic properties, or cellular receptors). In a first step, \nalternative qualitative and quantitative imaging biomarkers for the different \nmodalities (MRI, CT, PET) are elucidated. For magnetic resonance imaging, \nnew techniques with potential for treatment response monitoring such as \ndiffusion-weighted imaging, susceptibility \u0001weighted imaging, and elastography \nwill be assessed. Then, quantification of iodine uptake of contrast-enhanced \nCT as an imaging biomarker will be addressed. Novel PET imaging strategies \nfor therapy monitoring will be mentioned with focus on receptor targeting \ntracers (e.g. PSMA, DOTATOC). Furthermore, the role of PET-CT/MRI is \nmentioned to facilitate functional techniques in oncological imaging with \nimaging biomarkers. The potential clinical use of prior introduced biomarkers is \ndemonstrated for several cancer entities (e.g. HCC, prostate cancer, malign \nmelanoma, multiple myeloma, glioblastoma). Advantages and disadvantages \nof the illustrated imaging biomarkers are discussed during this part of the \nlecture.  \nLearning Objectives:\n1. To become familiar with alternative biomarkers for therapy monitoring. \n2. To understand different categories of imaging biomarkers. \n3. To learn about the use of emerging biomarkers for tumour assessment in \nselected cancer entities. \n4. To appreciate the advantages and disadvantages of emerging imaging \nbiomarkers for tumour response assessment. \nPanel discussion:  \nPersonalised response criteria for personalised therapies?  \n17:17\n16:00 - 17:30 Room F1  \nSpecial Focus Session  \nSF 15b  \nEvidence-based radiology, comparative \neffectiveness research, and health \ntechnology assessment  \nA-483 \n16:00 \nChairman's introduction  \nM.G.M. Hunink; Rotterdam/NL (m.hunink@erasmusmc.nl) \nIn today's health-care climate, there is an ever-increasing need to justify what \nwe do. Evidence-based radiology (EBR), comparative effectiveness research \n(CER), and health technology assessment (HTA) provide tools that help us \njustify imaging decisions. The tools in clude a hierarchy of study designs to \nevaluate diagnostic tests, checklists to appraise diagnostic studies, \nobservational studies, clinical trials, decision modelling, simulation studies, and \neconomic evaluation. Understanding these concepts is essential to use the \npublished results in justifying what we do. The goal is to image the right \npatient, at the right time, using the right test and with the right interpretation so \nthat patients will be advised on the right therapy. Ultimately, the aim is to \nmaximise patient outcomes at an affordable cost. This session will cover the \nstate of the art in EBR, CER, and HTA and demonstrate how the results are \nused in imaging decisions.  \nSession Objectives: \n1. To understand what is meant by evidence-based radiology (EBR), \ncomparative effectiveness research (CER), and health technology assessment \n(HTA). \n2. To understand the concept of imaging the right patient at the right time, \nusing the right test. \n3. To learn how to use evidence for justified imaging decisions in day-to-day \nclinical practice. \nAuthor Disclosure:\n M.G.M. Hunink: Advisory Board; NIPED Prevention Compass, Netherlands. \nAuthor; Decision Making in Health and Medicine. Employee; Adjunct \nappointment, Harvard University. Research/Grant Support; ZonMW and STW, \nNetherlands. \nA-484 16:05 \nEvidence-based imaging  \nF. Sardanelli; Milan/IT (f.sardanelli@grupposandonato.it) \nThe application of evidence-based medicine to medical imaging was relatively \ndelayed in comparison to other specialties. Radiologists should be aware of the \nnecessity to justify radiological examinations and imaging-based interventional \nprocedures on the basis of the best available evidence. Diagnostic tests can be \nevaluated with studies exploring th eir value in terms of: 1. technical \nperformance; 2. diagnostic performance; 3. diagnostic impact; 4. therapeutic \nimpact; 5. patient outcome; 6. societal impact. Notably, this is a one-way logic \nchain. While improvement at the upper levels implies improvement at some of \nthe lower levels, the vice versa is not always true (e.g., a better diagnostic \nperformance does not always imply a therapeutic impact or a better patient \noutcome). Moreover, different degrees of recommendations are based on \ndifferent levels of evidence, with experts' opinion as the lowest level of \nevidence and meta-analyses of high-quality homogeneous studies and \nmulticentre studies being the best level of evidence. The quality of studies \nneeds to be evaluated in terms of internal and external validity, the former \nregarding study implementation (pro tocol violations, reference standard, \nmeasurements, and readers' independence), the latter regarding study \nplanning (study design, subjects selection, methods, and statistical analysis). \nBiases influencing the internal validity limit the intrinsic value of study results, \nwhile those influencing external validity limit the generalisability of study results \nto clinical practice. Finally, high-qualit y research must be planned to build the \nevidence in favour of radiological procedures, especially for new technologies \nwhich tend to enter the market without any preliminary demonstration of \nefficacy.  \nLearning Objectives:\n1. To understand the different levels of evidence in the medical literature. \n2. To become familiar with the hierarchy of studies for diagnostic tests. \n3. To understand the concepts of internal and external validity. \n4. To learn how different forms of bias can influence reported results in the \nliterature. \n\nA B C D E F G S107  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-485 16:28 \nState-of-the-art methods in EBR, CER, and HTA relevant to imaging  \nU. Siebert; Hall i. Tirol/AT \nMore and more, clinical guideline developers and reimbursement decision \nmakers need to base their work and decisions on solid evidence. This \npresentation will introduce the key concepts and principles of evidence-based \nmedicine (EBM), comparative effectiveness research (CER), and health \ntechnology assessment (HTA) and their application to the field of radiology. In \nparticular, it will be discussed which role observational studies, clinical trials, \nand decision-analytic modeling play in EBR, CER, and HTA and when each of \nthese study types is needed to assess imaging technologies. Specific topics \ninclude the assessment of bias, optimising cutoffs and multiple test strategies, \nmaking causal inferences, explicitly weighing benefits, risks and costs, and \nconsidering ethical, legal and social implications (ELSI). \nLearning Objectives:\n1. To become familiar with state-of-the-art methods used in EBR, CER and \nHTA. \n2. To understand how observational stud ies, clinical trials, and decision-\nanalytic modeling all play a role in EBR, CER and HTA. \n3. To understand how these methods can be applied to the systematic and \nevidence-based evaluation of imaging tests. \nAuthor Disclosure: \nU. Siebert: Other; Department of Public Health and Health Technology \nAssessment, UMIT - University for Health Sciences, Medical Informatics and \nTechnology and ONCOTYROL - Center for Personalized Cancer Medicine, \nHall i., Department of Health Policy and Management, Harvard School of \nPublic Health and Department of Radiology, Massachusetts General Hospital, \nHarvard Medical School, Boston, MA, USA. \nA-486 16:51 \nTranslating EBR, CER, and HTA results into imaging decisions in daily \npractice  \nF.J. Gilbert; Cambridge/UK (fjg28@cam.ac.uk) \nThe excitement generated by the discovery of x-rays led to the early adoption \nof this technology in many hospitals around Europe. Over the last three \ndecades, the explosion of new medical imaging technologies together with the \nrecognition by clinicians of the value of these for their patients has meant that \nimaging budgets have increased exponentially. Evidence based radiology \n(EBR) is a relatively new approach designed to inform clinicians of the most \nappropriate technique to use in a given c linical scenario. The comparative \neffectiveness research (CER) is used by healthcare systems to develop a \nstrategic approach to rationalise the avail ability of imaging investigations. The \nHealth Technology Assessment (HTA) funding approach is a mechanism to \nassess new and emerging imaging technologies in a systematic timely manner. \nThe UK has a nationally funded healthcare system which is designed to deliver \nequitable care for the population free at the point of delivery. The challenge for \nthe UK has been to ensure the highest quality service by delivering the most \nappropriate technology and care for patien ts in a timely manner. The National \nInstitute for Clinical Excellence (NICE) is an independent body which gives \nguidance on new drugs and medical devices. This body requires robust \nscientific evidence on which to base thei r decisions. To create the evidence \nbase, the imaging studies need to be of a certain standard to be included \n(CONSORT, STARD, etc). An example from oncologic imaging will be used to \nshow how EBR influences daily practice.  \nLearning Objectives:\n1. To learn how EBR, CER, and HTA contribute to imaging decisions. \n2. To understand how EBR, CER, and HTA influence daily practice through an \nexample from oncologic imaging. \nAuthor Disclosure:\n F.J. Gilbert: Speaker; Bracco. \nPanel discussion:  \nCan EBR, CER, and HTA results provide justification for imaging \ndecisions and how do we implement the results?  \n17:14\n16:00 - 17:30 Room F2  \nSpecial Focus Session  \nSF 15c  \nChildhood abdominal emergency 2014:  \nthe dos and don'ts  \nA-487 16:00 \nChairman's introduction  \nE. Alexopoulou; Athens/GR \nAcute abdomen and abdominal trauma are both emergencies with potential \nfatal sequela when under/ misdiagnosed. Imaging plays a crucial role in the \ndiagnosis and management. US is the imaging technique of choice in most \ncases, as it is rapid, portable, lacks radiation and there is no need for sedation \nin young infants. US accuracy can be enhanced by iv contrast agents \nadministration. However, limitations may occur in obese children, in deep \nstructures, or because of gas filled bowel loops. On the other hand, CT \nprovides excellent visualisation without limitations by obesity, gas, or deep \nlesions. However, there is always the radiation exposure risk of the \nradiosensitive paediatric patient, while sedation is required in non co-operative \nyoung children. The aim of this session is to understand \"which\" is the modality \nof choice and \"why\", for the most common paediatric abdominal emergencies.  \nSession Objectives: \n1. To learn about the most common paediatric abdominal emergencies. \n2. To become familiar with the advantages and disadvantages of CT and \nultrasound in abdominal emergencies. \n3. To understand which is the modality of choice for abdominal emergencies. \nA-488 16:05 \nThe acute abdomen: US is the answer  \nS.G.F. Robben; Maastricht/NL (s.robben@mumc.nl) \nSeveral paediatric diseases are real abdominal emergencies. Any delay in \ndiagnosis and treatment may result in death or severe morbidity. These \ndiseases are highly age dependent. Newborn infants may have congenital \ndiseases as Hirschsprung's disease or meconium ileus or may develop \nnecrotising enterocolitis, incarcerated inguinal herniation and midgut volvulus. \nInfants and preschool children have intussusceptions, urinary tract infections \nand (rare) haemolytic uraemic syndrome. Children and adolescents have \nappendicitis, genito-urinary infections, ovarian torsion and Henoch Schonlein \npurpura. Considering radiation dose in children and the excess value of \nultrasonography (US) in small individuals, US plays an important role as initial \ndiagnostic modality in paediatric ab dominal emergencies . Sensitivity and \nspecificity for US in diagnosing intuss usception, midgut volvulus, urinary tract \nabnormalities and appendicitis is over  90%. Conventional abdominal \nradiographs or fluoroscopy are valuable in Hirschsprung's disease, meconium \nileus, malrotation and necrotising enterocolit is. I consider CT as an additional \ntechnique when the initial techniques (US and conventional radiography) are \ninconclusive. MRI is seldom indicat ed in paediatric patients with abdominal \nemergencies because of motion artefacts in anxious children and sometimes \nlimited MR capacity. Delay in diagnosis of the above-mentioned diseases may \nbe devastating, ranging from life-long disability to death. Therefore, it is \nimportant to consider these diagnoses and to initiate prompt adequate \ndiagnostic workup.  \nLearning Objectives:\n1. To learn about the most common and devastating paediatric abdominal \nemergencies. \n2. To understand the value of ultrasonography in acute abdomen. \n3. To understand the consequences of any delay in diagnosis. \nA-489 16:23 \nThe acute abdomen: CT is the answer  \nA. Paterson; Belfast/UK (anniezunz@gmail.com) \nAbdominal pain is a common symptom in children, and whilst the majority will \nhave a self-limiting condition, in some the pain may indicate an acute medical \nor surgical condition that requires prompt investigation and treatment. In the \npaediatric setting, the primary imaging modality for those with an acute \nabdomen is ultrasound. However, there are certain patient groups - often older \nchildren or adolescents - in whom CT plays an important role. It is well \nacknowledged that CT is non-operator dependent: an important factor for \nchildren presenting to emergency departments outside children's hospitals. \nThe speed of a CT exam is valuable in the acute setting, as is the capability to \nobtain images without having to touch the tender abdomen of a distressed \nchild. CT offers a global perspective of the abdomen, and image quality is not \nhindered by the presence of excessive bowel gas, an abnormal body habitus \n\nA B C D E F G S108  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nor in the obese patient. CT is especially helpful in those with suspected \nretroperitoneal pathology, in the inve stigation of immunocompromised patients \nand those with complex post-operative problems. CT guidance may be \nrequired to facilitate percutaneous abscess drainage, particularly for deep \npelvic collections. In addition, CT plays a vital role as a 'problem-solver' when \nultrasound has failed to fully answer the cl inical question posed. This short \npresentation will utilise clinical studies to illustrate the benefits of CT in the \ninvestigation of the acute abdomen, both as the initial imaging modality and as \na second line tool following ultrasound.  \nLearning Objectives:\n1. To understand the advantages of CT as a primary imaging modality for \nchildren with acute abdomen. \n2. To learn about clinical scenarios in which CT is relevant. \n3. To appreciate the use of CT as an adjunct to ultrasound. \nA-490 16:41 \nAbdominal trauma: US is better  \nV. Miele; Rome/IT (vmiele@sirm.org) \nUltrasonography (US) is a reliable technique whose advantages are rapidity, \nportability and accuracy in depicting intraperitoneal fluid without interrupting \nresuscitation and without radiation exposure. In the haemodynamically \nunstable paediatric patients, it represents the first line together with the x-ray \nevaluation. US for trauma has become more standardised and is worldwide \nknown with the acronym of FAST (focused abdominal sonography for trauma) \nor E-FAST (extended-FAST) used in depicting also pleural and pericardial \neffusions and pneumothorax. Nevertheless, many parenchymal injuries are not \ncorrectly visualised at baseline US and some traumatic solid organ lesions can \noccur without hemoperitoneum. In case of haemodynamically stable patients, \nwho have suffered a low-energy trauma, the greater time available allows the \nuse of specific US contrast agents, enabling a better identification of traumatic \norgan injuries. Contrast-enhanced ultrasonography (CEUS) has a greater \nsensibility and specificity in the identification of parenchymal traumatic lesions, \nboth in the first evaluation and fol low-up, and could avoid unnecessary \nradiation and iodinated contrast medium exposure. In case of \nhaemodynamically stable paediatric pati ents, who have suffered a high-energy \ntrauma, US is not recommended as first-line investigation, because CE-MDCT \nshould be performed first. Only in the follow-up, CEUS can be considered an \nalternative to CT. In conclusion, E-FAST and CEUS should be considered as a \nuseful tool in the assessment and monitoring of paediatric trauma. This \nexamination can be performed at the patient's bedside, representing a useful \nalternative to CT in the paediatric traumatised patients and in the follow-up of a \nknown abdominal injury.  \nLearning Objectives:\n1. To understand the differences in the diagnostic paths of paediatric patients. \n2. To learn about the diagnostic efficacy and limitations of ultrasonography. \n3. To become familiar with the use of the contrast-enhanced ultrasonography \n(CEUS). \nA-491 16:59 \nAbdominal trauma: CT is better  \nM. Raissaki; Iraklion/GR (mraissaki@yahoo.gr) \nCT has been considered a sensitive, specific, and accurate test in the \nidentification and grading of injuries, especially in the severely injured child. It \nshould be overemphasised that traumatised children differ from adults: \nhaemodynamically stable children may actually be actively bleeding and \nrapidly deteriorate. Conversely, children have smaller calibre vessels, stronger \nvasoconstriction, and stronger solid organ capsules; bleeding may stop \nspontaneously, organ rupture is more difficult and delayed rupture is rare. This \nis why few children will undergo laparotomy or trans-arterial embolisation. The \ngoal of imaging is to clear the abdomen in multi-traumatised children, identify \nthose that may rapidly deteriorate because of clinically silent active bleeding, \nincrease the surgeon's confidence level and define short- and long-term \nmedical management. Due to children's increased radiosensitivity, all CT scans \nshould be indicated based on appropriate earl y clinical evaluation, assessment \nof risk factors for abdominal injuries and evaluation of the closely monitored \nchild. ALARA includes the availability of outside scans upon admission, \navoiding non-contrast scans and multiple phases and applying age- and \nweight-dependent exposure parameters. CT should not be performed as \nfollow-up unless there is clinical deterioration. CT has the advantage of rapidly \nidentifying and delineating with high resolution solid organ, vascular, \nmesenteric, bowel injuries and pending oligaemic collapse (hypoperfusion \ncomplex or shock bowel). Important fractures and thoracic injuries may be \nsimultaneously revealed with CT. The objective documentation of intra-\nabdominal injuries is extremely important in suspected child abuse.  \nLearning Objectives:\n1. To understand that children are not small adults. \n2. To learn about trauma CT protocols according to the ALARA principle. \n3. To become familiar with types of injuries, which can be appropriately \nevaluated with CT. \nPanel discussion:  \nUS or CT in paediatric abdominal emergencies?  \n17:17\n16:00 - 17:30 Room G/H  \nNeuro  \nRC 1511  \nSpine, cord and intervention  \nModerator:  \nC. Hoffmann; Tel Hashomer/IL \nA-492 16:00 \nA. Intramedullary pathology  \nM.M. Thurnher; Vienna/AT (majda.thurnher@meduniwien.ac.at) \nEvaluation of MR imaging in a patient with an intramedullary lesion should \nfocus on key features: a) the location of the lesion on the cross-sectional area \nof the cord, best evaluated on axial images, b) the length of the lesion \nevaluated on sagittal images, c) the prese nce of cavitation and cysts, d) signal \nintensity on T2-WI, e) the presence of enhancement and enhancement type, \nand f) associated leptomeningeal enhancement. The knowledge of the \npresence or absence of the brain lesions is important information for narrowing \nthe differential diagnosis. T he clinical picture and the onset of symptoms will \nhelp the differentiation between the neopl astic and inflammatory and vascular \nlesions. In this lecture, the imaging characteristics and typical patterns of \nintramedullary lesions will be presented. A diagnostic algorithm, which includes \nimaging, clinics and CSF analysis, will be discussed.  \nLearning Objectives:\n1. To become familiar with the differential diagnosis of intramedullary lesions. \n2. To learn how to differentiate between inflammatory, vascular and neoplastic \ncord disease. \n3. To recognise the most common intramedullary lesions. \nA-493 16:30 \nB. Spondylodiscitis, degenerative or tumoural?  \nG. Lycklama à Nijeholt; The Hague/NL (g.lycklama@mchaaglanden.nl) \nA common clinico-radiological situation is the differentiation between spinal \ninfection, degenerative changes and osteopaenia, and spinal tumour. In most \ncases, conventional CT and/or MRI will allow a certain differentiation, and \nadditional biopsies are mainly used to obtain tissue for bacteriological or \nhistopathological classification. Advanced MR techniques such as DWI may \nsometimes help in increasing diagnostic certainty, but are seldomly used in \nday-to-day practice. Spinal infections typically present around the intervertebral \ndisc, but may also present as isoloated spondylitis without disc involvement, \nand sometimes the infection quickly spreads to the epidural space. \nDegenerative changes my sometimes mimic infection due to strong gadolinium \nenhancement. The main differential diagn osis of spinal tumorous processes is \nosteopaenic changes (oedema), and CT may be helpful in such cases, for \nexample to demonstrate degenerative gas in the vertebral body. Rare causes \nof spinal abnormalities such as atypical pathogens and rare tumours may \ncause diagnostic problems; often the fastest road to a diagnosis is biopsy in \nthose cases.  \nLearning Objectives:\n1. To understand the pathogenesis of degenerative and infectious spinal \ndisease. \n3. To become familiar with the diagnostic algorithm of patient selection. \n4. To understand the natural evolution and treatment effects of spinal disease. \nA-494 17:00 \nC. Percutaneous treatment of spinal diseases  \nM. Muto; Naples/IT (mutomar2@gmail.com) \nThe correct clinical diagnostic approach to spine disease is mandatory in the \nselection of patients to be treated. The anatomy and the relationship between \ndifferent structures must be known in detail to understand the source of the \npain and so to treat it percutaneously. MR, CT, dynamic x-ray and NM bone \nscan in selected cases can be used to understand the reason for the pain. MR \nwith T2 STIR sequence or T2 Fat SUPP technique is mandatory to show bone \nmarrow oedema and to decide on which metamer to perform the treatment. CT \nis often necessary after MR in primary and secondary spine tumours. Disk \ndisease can be seen either on CT or MR. Two major treatments must be \nconsidered: discogenic pain and vertebrogenic pain, and for this reason disk \ntreatment and vertebral treatment. Disk treatment includes many mini-invasive \nsystems to use; however, no treatment has been shown to be superior to the \nothers, with good clinical results in 75-80% of the cases, even at long-term \nfollow-up. VP and assisted techniques are available for the treatment of not \n\nA B C D E F G S109  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nonly porotic fragility fractures, but also of primary and secondary spine tumours \nsuch as traumatic fractures.  \nLearning Objectives:\n1. To understand the clinical indications for percutaneous treatment of spinal \ndiseases. \n2. To learn which diagnostic modality to suggest. \n3. To become familiar with the different percutaneous techniques available. \n16:00 - 17:30 Room I/K  \nHead and Neck Imaging  \nCC 1519  \nTailoring head and neck examinations to \nthe clinical symptoms (part 1)  \nModerator:  \nM.I. Furmanek; Warsaw/PL \nA-495 16:00 \nA. Impaired eye movements  \nM.G. Mack; Munich/DE (m.mack@radiologie-muenchen.de) \nA wide variety of lesions in and around the orbita can impair eye movement. \nCT and MR imaging is frequently used to confirm or exclude lesions in and \naround the orbit in patients with impaired eye movement. First of all, it is very \nimportant to know the exact clinical history of the patients. CT is excellent for \nconfirming a mass; however MRI is more sensi tive and arrives often at a single \nmost likely diagnosis. Characteristic imaging features may help distinguish \namong lesions that have overlapping clinical presentations. This review \nfocuses on some of the common orbital masses. In this lecture common \nbenign and malignant lesions will be discussed. Vascular lesions include \ncapillary (infantile) haemangioma, cavernous haemangioma, and \nlymphangioma. Benign tumours include optic nerve sheath meningioma, \nschwannoma, and neurofibroma. Malignancies that are reviewed include: \nlymphoma, metastasis, rhabdomyosarcoma, and optic glioma. In addition, \nbenign and malignant lesions affecting the eye movement from outside of the \norbit (e.g. from the paranasal sinuses, nasopharynx and skull base) will be \ndiscussed.  \nLearning Objectives:\n1. To learn about impaired eye movement and understand its causes. \n2. To learn about the imaging algorithm. \n3. To become familiar with differential diagnosis. \nA-496 16:30 \nB. Trigeminal neuralgia  \nA. Borges; Lisbon/PT (borgalexandra@gmail.com) \nTrigeminal neuralgia is a unique form of facial pain, defined by the International \nAssociation for the Study of Pain as a sudden, unilateral, brief, stabbing, \nrecurrent pain in the distribution of one or more trigeminal nerve branches, \ntriggered by a specific event. Additional  diagnostic criteria of the International \nHeadache Society include paroxysmal, stereotypic pain attacks and absence \nof associated neurological deficits. It is due to trigeminal nerve compression at \nthe root entry zone, a transitional zone between central and peripheral \nmyelination, where the myelin sheath is thinner and more prone to \ncompression and electrical stimulation. The most common cause is vascular \ncompression, by aberrant loops of the SCA, AICA, PICA or vertebro-basilar \ndolichoectasia, leading to a neurovascular conflict. Small size of the prepontine \nand CPA cisterns has been identified as a predisposing factor. Occasionally, \nexpansile lesions of the skull base or CNS compress the root entry zone and \nlead to atypical trigeminal neuralgia. MR imaging is the modality of choice to \nevaluate these patients and requires specific tailored protocols to depict its \ncauses, including 3D heavily T2W images reconstructed in the three planes \nand an angiographic sequence for the depiction of neurovascular conflicts. As \nneurovascular contacts are quite common in the general population, strict \nimaging criteria for the diagnosis of NVC have emerged. The offending vessel \nneeds to cross the nerve perpendicularly and deviate or indent its course at the \nREZ. A pictorial review of the most co mmon causes of trigeminal neuralgia and \ntrigeminal neuropathy will be presented.  \nLearning Objectives:\n1. To understand the causes of trigeminal neuralgia and its clinical symptoms. \n2. To learn about the relevant anatomy and appropriate imaging methods. \n3. To become familiar with the relevant radiological images, differential \ndiagnosis and limitations of the method. \nA-497 17:00 \nC. Facing problems of the face: facial pain, tics and palsy  \nB. Verbist; Leiden/NL (b.m.verbist@lumc.nl) \nFacial impairments may be due to neuropathies of the trigeminal and facial \nnerve. This lecture will focus on the seventh cranial nerve. This nerve is a \ncomplex, mixed nerve with motor fibres, parasympathetic fibres, sensory fibres \nto the external auditory canal and special sensory (taste) fibres to the tongue. \nThe most common presentation of facial nerve dysfunction is facial palsy. The \nparesis or paralysis of facial muscles may be caused by several conditions \nsuch as developmental abnormalities, infectious or inflammatory disease or \ntumoural lesions. Other presentations of fa cial nerve dysfunction are facial tics \nor hemifacial spasm and pain. The indi cations for imaging, choice of imaging \nmodality and possible imaging findings in  case of facial palsy, facial tics and \nfacial nerve-related pain will be discussed.  \nLearning Objectives:\n1. To understand the possible causes of facial impairments. \n2. To become familiar with the cranial nerves involved. \n3. To learn how to choose appropriate imaging modality and which critical \nstructures to evaluate. \n16:00 - 17:30 Room L/M  \nPhysics in Radiology  \nRC 1513  \nIT tools for dose tracking and workflow \noptimisation\nModerators:  \nP. Mildenberger; Mainz/DE \nA. Trianni; Udine/IT \nA-498 16:00 \nA. DICOM and IHE standards  \nD. Peck; Detroit, MI/US (donaldp@rad.hfh.edu) \nThe development of the DICOM Standard is done through Working Groups of \nthe DICOM Standards Committee. The Working Groups perform the majority of \nwork on the extension and corrections to the Standard. The extensions are \nmade through development of Supplements and corrections are done through \nChange Proposal (CP) mechanism. In this presentation, the procedures used \nto create the Standard will be reviewed and some of the most recent changes \ndiscussed. As a collaboration of pr ofessional societies and companies, \nIntegrating the Healthcare Enterprise (IHE, www.ihe.net) seeks to establish \nmethods wherein health computer systems can communicate to achieve \nspecific functional objectives. These involve development of methodologies to \nimplement standards such as DICOM, HL7, etc. In this presentation, the \nprocedures used to create the IHE profiles will be reviewed.  \nLearning Objectives:\n1. To understand the current DICOM standard. \n2. To learn about new DICOM efforts that will significantly impact imaging \nsystems operations. \n3. To understand how IHE coordinates the integration and management of \nDICOM objects. \nA-499 16:30 \nB. Patient dose tracking: a must have?  \nW. Pavlicek; Scottsdale, AZ/US (pavlicek.william@mayo.edu) \nPatient Dose Tracking is rapidly growing in the USA as a large number of \ncommercial products are available in response to user demand. These \nproducts leverage the work that has gone into the development of the DICOM \nDose Structured report and the proliferati on of digital imaging systems. Medical \nphysicists are crucial team members as they are most capable of performing \npatient dose measurements and calculations. Noteworthy is that the 'toolbox' of \nthe medical physicist is expanding. Informatics with Patient Dose Tracking \ntools invariably includes familiarity at some detail with DICOM structure and \ntags, Dose Structured Reports (SR), SR Readers, RIS content and orders, \nmodality work list broker content, modality (imaging) specific content as well as \nPACs, Archive rules for storage/retrieval and EMR. Patient-specific information \nand the highly detailed specifics of the individual dose prescription are \nnecessary for advanced estimates of information. A Dose Tracking system (a \nQA tool outside of the normal imaging device that uses content provided by \nDose SR and other information systems) usually strives to elevate the quality \nof the dose estimate, using informatics tools such as patient and organ models, \ndosimetry engines, and predictive stati stics. General use cases for Dose \nTracking will be presented including advanced dose estimations for individual \npatient exams and QA review for both CT and fluoroscopy. Examples of \n\nA B C D E F G S110  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\ntracking of prescriptions by patient, protocol/procedure and operator for \ndetermination of patient dose history, 'outliers', continuous improvement (using \nDMAIC tools) or for meeting regulatory or accrediting bodies will be included.  \nLearning Objectives:\n1. To identify informatics and tools for tracking patient radiation dose. \n2. To learn about some possible use cases in clinical practice. \n3. To learn about some examples of patient radiation dose tracking. \nA-500 17:00 \nC. To identify pitfalls and support technique optimisation  \nE. Vaño; Madrid/ES (eliseov@med.ucm.es) \nWith the introduction of digital radiology, it is possible to have automatic \nsystems to collect and archive patient dos e data individually, in addition to \ndemographic, geometric, and other procedural parameters, as part of the \nDICOM header or through other DICOM services. These automatic systems \nmean significant benefits for patient dosi metry and quality control. Different \napproaches were used, depending on the availability and level of \nimplementation of the DICOM standard, including extracting the technical \ninformation from the headers, using the radiation dose structured reports \n(which contain accumulated dose over seve ral irradiation events), analysing \nthe MPPS messages sent by the modalities to the radiology information \nsystem, and implementing optical char acter recognition techniques on saved \nscreen images. Before issuing a formal patient dose report, the medical \nphysicists should verify and correct all patient dose data. All these approaches \nallow managing more information and provide better capacity to audit the full \nimaging procedure and to help with the optimisation. The current level of \ntechnology allows doing so at a reasonable cost and with a great benefit for the \nclinical practice. Automatic detection of abnormal patient doses or mistakes in \nthe technical parameters used and their prompt correction is possible. \nDiagnostic reference levels will be effortlessly reviewed with such systems. \nSome examples of pitfalls and possible optimisation actions will be presented.  \nLearning Objectives:\n1. To learn about sources of information that could help in identifying possible \npitfalls. \n2. To understand how to interpret the data stored. \n3. To learn about some examples of pitfalls and possible optimisation in clinical \npractice. \n16:00 - 17:30 Conf. Room M3  \nOncologic Imaging: Follow-up of Systemic and Local Therapies  \nCC 1518  \nFollow-up of thermal ablation (part II)  \nModerator:  \nR. Bale; Innsbruck/AT \nA-501 16:00 \nA. Follow-up imaging of thermal ablative therapies for lung tumours  \nT. De Baere, F. Deschamps, L. Tselikas; Villejuif/FR (debaere@igr.fr) \nWithin a few minutes following ablation, CT of the ablation zone will \ndemonstrate an extensive area of ground glass opacity (GGO). A GGO of at \nleast 4.5 mm peripheral to the tumour is predictive of complete ablation. As \nearly as 24 hours post-treatment, the entire ablated region usually appeared as \na well-demarcated homogeneous dense opacity on CT that corresponded to \nnecrotic tissue and its surrounding rim of granulation tissue. This zone of \nablation is the \"baseline post-ablation imaging\" for follow-up. Then, a relatively \nslow involution of the ablation zone will occur with various patterns, including \nnodular, fibrosis, disappearance, ca vitation and atelectasis. Morphologic \nfeatures of local tumor progression are an increase in the overall size or a \nchange in the shape of the ablation zone (even without enhancement). It is \ngenerally considered that an ablation volume that does not increase in size on \nsubsequent imaging after the baseline post-ablation imaging is a complete \nablation. The relatively slow decrease in  size of the ablation zone renders CT \nmorphologic evaluation responsible for late discovery of local tumour \nprogression. PET/CT is able to discover incomplete ablation earlier than CT at \na stage the disease remains small. Patients who have very early evaluation \nwith PET/CT are at risk of either false -positive result due to early inflammation \nprocess, or false-negative result due to early inflammation masking active \ntumor foci. 3 or 6 months after ablation can be a reasonable time for PET/CT.  \nLearning Objectives:\n1. To consolidate knowledge on the imaging aspects of successful ablation. \n2. To become familiar with the main pitfalls of post-ablation imaging. \n3. To learn about the imaging aspects of most common complications. \nA-503 17:00 \nC. Follow-up imaging of thermal ablative therapies for kidney tumours  \nD.J. Breen; Southampton/UK (David.Breen@uhs.nhs.uk) \nImage-guided ablation of kidney tumours has been increasingly set to become \nthe standard of care treatment for smaller ( < 5 cm) renal tumours, yet ablation \nremains a non-extirpative technique and is therefore paramount, in this \ncurative setting, that imaging follow-up should reliably confirm complete tumour \neradication. Early on in radiofrequency ablation (RFA), control remained \nproblematic and inadequate treatment was evidenced by residual marginal \ncrescents of viable, enhancing disease. In the current era of more definitive \nablation with multipolar techniques, cryo- and microwave ablation (MWA), this \npattern of treatment failure should rarely, if ever, be encountered. Typically \nfollowing adequate ablation imaging should confirm a completely non-\nenhancing tumour and a related cortical ablation zone. Whilst non-\nenhancement is an accepted surrogate of tumour non-viability, most \npractitioners look for additi onal collateral features such as the 'halo' sign, \nappearing as a soft tissue ring in the adjacent peri-renal fat, usually a sound \nmarker of complete tumour eradication. Follow-up data have shown that \ncryoablation (CRA) can yield robust outcomes, but often incurs notable \nhaemorrhagic change and a 'rind-like' feature around the ablation zone. CRA \nalso appears to induce faster involution of the treated tumour, whereas RFA \nand MWA can induce a persistent granulomatous mass which only very slowly \ninvolutes over a number of years. Late local recurrence is increasingly rare at \naround 2-3%, but can occur as nodules of enhancing disease as late as 3-6 \nyears after the initial treatment. Subtraction MR can be useful, but to date PET \nand perfusion techniques still lack resolution and specificity.  \nLearning Objectives:\n1. To learn about the post-ablation aspects, according to the ablation technique \nused. \n2. To become familiar with the imaging aspects of successful ablation. \n3. To appreciate the imaging aspect of most common complications. \nA-502 16:30 \nB. Follow-up imaging of percutaneous local treatment of bone tumours  \nA. Gangi, J. Garnon, G. Tsoumakidou; Strasbourg/FR (gangi@unistra.fr) \nMultiple percutaneous image-guided therapies are currently available for \nthermal ablation of bone tumours. Thermal sources for these treatment \nmodalities include high-intensity ultrasound, laser, microwave, radiofrequency, \nand cryotherapy. The predictability of thermal ablation is adequate to limit \ncollateral damage and complications, however, is limited by biologic and \nanatomic variability of tissue. Clinical ev aluation is essential in symptomatic \ntumours. Close imaging follow-up with CT, MRI, bone scan, and PET plays a \nvital role in the management of the pos t-thermal ablation patient and detection \nof complications. Recurrences or regrowth can be considered for repeated \nthermal ablation if the lesion is discovered early, before the tumour geometry, \nlocation, or distribution become unfavoura ble. The imaging features could vary \nwith the different ablation method. The radiologist reporting the follow-up \nimaging should be familiar with different ablation methods. MRI with dynamic \ncontrast enhanced imaging and subtraction allows to detect recurrences in \nhypervascular tumour. Contrast enhancement on T1-weighted MRI imaging \nseems to be predictive of clinically unsuccessful ablation. On CT scan, bone \nreconstruction can be visualised but is a slow process, particularly in adults. \nPET scan is an excellent morphologic and metabolic image to follow-up the \ntumours. However, the inflammation produce after ablation can be misleading, \nparticularly during the first three months. Imaging follow-up plays an essential \nrole in the management of the post-thermal ablation patient and detection of \ncomplications.  \nLearning Objectives:\n1. To learn about the post-ablation aspects, according to the ablation technique \nused. \n2. To consolidate knowledge on the imaging aspects of successful ablation \nfrom various types of follow-up imaging, including CT and MRI. \nAuthor Disclosure:\n A. Gangi: Other; Proctoring Galil Medical. \n\nA B C D E F G S111  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n16:00 - 17:30 Board Room A  \nRadiographers  \nRC 1514  \nThe interventional suite of 2014: \nresponsibilities and challenges  \nModerators:  \nK. Haller; Wiener Neustadt/AT \nB. Marincek; Cleveland, OH/US \nA-504 16:00 \nA. Today's technology: requirements for a cutting-edge interventional \nsuite  \nD. Catania; Milan/IT (cataniadiego@hotmail.com) \nInterventional radiology (IR) is an evolution of radiology that treats many \ndiseases, originally treated by traditional  surgery. The clinical importance of IR \nhas been demonstrated over the years by performing procedures that offer the \nbenefit of therapeutic treatments, competitive from the point of view of a \nshorter hospitalisation time. Indeed, thanks to IR, patients are treated in a less \ninvasive manner, hospitalisation is limited and thus promotes the containment \nof social costs. To maintain standards clinical oversight needs to focus upon \ncorrect organisational, functional and technological appropriateness of \npractice. To achieve correct IR performance, it is necessary to guarantee that \nall the instrumental guides (fluoroscopy, ultrasound, computed tomography \nequipment) function optimally, the procedural equipment including \nguides/catheters/stents, etc. are chosen according to their technical features \nand their characteristics are appropriate for use, incorporating cost \nconsiderations. As the complexity and variety of interventional procedures \ngrow, there is an increasing need to ensure the appropriate training of \nspecialised IR staff. Consideration of  dedicated education and continued \nprofessional development options for radiog raphers working in IR is of priority. \nThe Italian Association of Interventional Radiographers (AITRI) is very \nimportant in sharing guidelines in a multidisciplinary environment to \nstandardise and harmonise the knowledge and skills of the team in hybrid \ntheatre and interventional suites. Interventional radiology technology is rapidly \nexpanding and, to maintain safe and effi cient practice, careful consideration of \ncurrent and potential future organisational  needs and the training of staff within \nan IR suite require detailed consideration.  \nLearning Objectives:\n1. To learn about interventional procedures and their impact on economic \nfactors and outcome. \n2. To become familiar with the range of technologies in interventional radiology \nsuites and hybrid theatres. \n3. To appreciate the staffing requirements associated with interventional \nradiology suites and hybrid theatres. \n4. To appreciate the education and training needs of radiographers working in \ninterventional radiology. \nA-505 16:30 \nB. Radiation risk and radiation protection considerations  \nA. Widmark; Østerås/NO (anders.widmark@nrpa.no) \nThe lecture will discuss where new and current knowledge about radiation risk \nand effects are coming from. A brief overview of the different sources of \nknowledge, including Hiroshima and Nagasaki Life Span Study, will be given. \nThe most important stakeholders involved in research and formulating \nguidelines for radiation protection, with special emphasis on the new main \npublication from the International Committee on Radiological Protection \n(ICRP), and the impact on radiographic practice will be discussed. New tissue \nweighting factors for breast glandule gives a significant higher risk for females \ntoday, especially in the pubertal age. On the other hand, they have the risk for \nhereditary effects significantly decreased. Estimation of risk, both in general \nand in the individual, will be discussed. Regarding staff protection, there is a \nnew recommendation for annual dose limit for the eye lens. The previous \nannual dose limit was 150 mSv, and this is now recommended to be \ndecreased to 20 mSv averaged over five years with no single year exceeding \n50 mSv. The new recommendation can be a limiting factor in interventional \nradiology and cardiology, if sufficient protection is not used.  \nLearning Objectives:\n1. To understand the importance of radiation protection in interventional \nradiology for patients and staff. \n2. To appreciate the latest recommendations for staff radiation protection in \ninterventional radiology. \n3. To appreciate the important role of the interventional radiographer in \nradiation protection. \nA-506 17:00 \nC. Changing professional roles  \nB. Hallinan; Dublin/IE (barryhallinan@beaumont.ie) \nThe improvement of patient care and aims for the highest possible levels of \nservice are to the forefront of the modern \"interventional suite\". Role \ndevelopment experiences will be explored, considering need, effect and \nmanagement of development. Service demands, the need to extend those \nprovided, the limited number of radiologists, financial constraints and the \nrequirement for continuous professional development at state level provide \nmuch stimulus for professional radiogr aphic role development. Increased job \nsatisfaction, reduced waiting lists and improved patient experience all provide \nlargely positive results it appe ars. Resistance from radiologists, \nmultidisciplinary team members and radiographers themselves however, can \nprovide unnecessary barriers to change. Once abridged the blurring of \nprofessional lines and insecurity within multidisciplinary team members may \nalso occur. Various experiences would suggest that only by allowing ownership \nof change by all the clinical stakeholders involved, thus empowering them, \nleads to successful development. On exam ination clear guidelines and distinct \nprotocols must be established, taking account of current workload, to create \nthe ideal scenario for good multidisciplinary team ethos, where members have \noverlapping yet clearly defined roles. Professional accountability, responsibility \nand an understanding of those role's are all key, but without correct training, \nincluding support and resources, no regime for role development can be \nachieved successfully. Clinical audit not only ensures the delivery of high \nquality and effective care in line with best practice, whilst ensuring cost \neffectiveness, but also provides the confidence for all involved, especially the \ninterventional patient.  \nLearning Objectives:\n1. To understand the factors influencing change in professional roles within \ninterventional radiology. \n2. To learn about the potential impact of enhanced professional roles and a \nmultidisciplinary team approach on service delivery and patient outcomes. \n3. To understand the need for clear protocols and guidelines along with \nappropriate training and audit of practice when implementing such changes. \n16:00 - 17:30 Room P  \nENCITE Session  \nENCITE based insights for molecular \nimaging in guidance of therapy  \nModerator:  \nM. Neeman; Rehovot/IL \n16:00 \nIntroduction  \nM. Neeman; Rehovot/IL (michal.neeman@weizmann.ac.il) \nA-507 16:05 \nA dual-modality gene reporter for in vivo imaging  \nK. Brindle; Cambridge/UK (kmb1001@cam.ac.uk) \nThere have been many attempts to develop gene reporters for MRI, however \nthese give relatively modest image contrast  that can be difficult to detect. I will \ndescribe in this talk a reporter that gives intense and positive contrast in MR \nimages (up to ~8x increase in signal), which can also be used with radionuclide \nimaging, thus combining the sensitivity of radionuclide imaging with the spatial \nresolution of MRI. The contrast obtained is directly related to the degree of \ngene expression and is readily reversible, thus allowing longitudinal studies of \nchanges in expression.  \nAuthor Disclosure:\n K. Brindle: Research/Grant Support; GE Healthcare. \nA-508 16:20 \nMR imaging for pancreatic cells transplantation  \nM. Hájek, D. Jirák, V. Herynek; Prague/CZ (Milan.Hajek@medicon.cz) \nThe transplantation of pancreatic islet into the liver is an excellent example of \nsuccessful cell therapy. Transplanted islet visualisation in vivo using a non-\ninvasive imaging method, for example MRI, is necessary to prove technical \nsuccess. Monitoring of transplanted islets in vivo and long-term tracking their \nfate using MRI requires their labelling by a suitable contrast agent in vitro prior \nto transplantation. Under ENCITE project we successfully performed animal \nexperiments, which proved therapy potential of labelled pancreatic islets. \nLabelled islets implanted into the rat liver were viable and induced long-term \nnormoglycemia in diabetic rats. MRI proved their viability and even distribution \nin the host tissue. These results allowed performing a clinical study on a group \nof 12 patients, which were transplanted by iron labelled pancreatic islets from \ncadaver donors. The successful pilot experiment enabled introducing of \n\nA B C D E F G S112  \nSunday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\ntransplantation of native islets into routi ne clinical practice. Search for better \nalternative sites, improved immunosup pression and alternative insulin-\nproducing cells require multimodal and multifunctional molecular probes. \nCurrently we test polymer meshes as artificial transplant sites, effect of \nmesenchymal stem cells as a supportive net for beta cells, and novel cellular \nprobes combing 1H, 19 F labels and fluorescent ones.  \nA-509 16:35 \nOptical imaging in the clinic  \nJ. Dijkstra; Leiden/NL (j.dijkstra@lumc.nl) \nRecently a lot of developments have been done in the field of optical imaging. \nNew sensitive devices made it possible to use both visible and near infrared \nlight as diagnostic tool and guidance tool. The advantage of near infrared is \nthat the penetration depth in tissue is much better than for visible light, allowing \nto see deeper. By using techniques like augmented reality, the data from \ninfrared, both anatomical and functional, can be presented to the operator in \nreal-time. Optical imaging is used e.g. as an evaluation tools for \nmammography where the optical spectral properties of the tumor cells is used \nto monitor the effectiveness of chemo treatment. The spectral properties of the \nbreast are measured using a laser at different wavelengths and a camera to \ncreate tomographically a 3D volume. Dedicated near infrared probes which \nbind to certain tissue types make it possible to look for e.g. remaining tumor \ntissue in resection margins during surgery. This techniques also allow to \nvisualise structures which should be avoided during procedures like nerves. By \nadding multispectral imaging, the endogenous contrast can be used. Different \ntissues have their own absorption spectrum which can be shown as additional \ninformation, for instance the ration Hb/HbO2. Optical imaging also allows for \nacquiring images at near microscopic resol ution real time in-vivo by using \nOptical coherence tomography. This modality is being tested to provide \ninformation about the presence of certain cell types very fast where otherwise \nhistology is needed.  \nA-510 16:50 \nMesenchymal stem cells constructs for image-guided cell therapy in \nmyocardial ischemia and digestive fistulas  \nO. Clément, E. Blondiaux, G. Rahmi, L. Pi dial, A. Silva, F. Gazeau, C. Wilhelm, \nG. Autret; Paris/FR (olivier.clement@inserm.fr) \nRegenerative medicine has recently emerged as a potential therapeutic tool. A \nnumber of preclinical and clinical trial s have been conducted in many diseases \nranging from diabetes to myocardial infarction and neuro-regenerative \ndiseases that assess the feasibility and benefits of injecting stem cells. \nHowever, outcomes relating to graft survival remain generally unsatisfactory, \nwhether the process of injection is direct, intravenous or catheter-guided. To \novercome such issues, tissue engineering has potential to improve cell \nengraftment and therapeutic response including functional parameters. This \nwork aimed to evaluate mesenchymal stem cell constructs for image-guided \ncell therapy in myocardial ischemia and di gestive fistulas. We tried to options: \n1. Fibrin patches based on fibrinogen monomers polymerised with thrombin \nand seeded with cells. 2. Constructs based on 3D multilayers of confluent cells \nsheets. Tissue constructs were labelled with iron oxide particles and evaluated \nin a model a myocardial infarction for t he fibrin patches or digestive fistula for \nthe 3D constructs. MRI at 4.7 was performed at various time points after \ntreatments using a high resolution coil. Fibrin patches could induce a \ntherapeutic effect by increasing the left ventricular ejection fraction compared \nto sham. 3D constructs induced an increased number of fistula healing and \nenhanced micro-vasculature density compared to controls. MRI of labelled \nstem cell constructs allowed a good evaluation of the models and showed \nincreased therapeutic efficacy. The proposed paracrine mechanisms will be \ndiscussed.  \nA-511 17:05 \nIs cell imaging relevant for the clinic? Lessons to be learned from pre-\nclinical research  \nU. Himmelreich; Leuven/BE (Uwe.Himmelreich@med.kuleuven.be) \nNon-invasive imaging of therapeutic cells has become a popular field of \nresearch over the last decade. This interest was mainly based on the hope that \nthe location, migration but also function of immune, stem and other cells can \nbe visualised over time in individu als. The development of novel contrast \nagents and mechanisms for MRI but also other imaging methods has resulted \nin exciting basic research findings. In parti cular, the application of relatively bio-\ntolerant iron oxide based nanoparticles has fostered the hope for direct \ntranslation into clinical research and general practice. However, pre-clinical \nresearch has also highlighted several limitations of nanoparticle based cell \nimaging by using MRI including the generation of unspecific contrast, \ndifficulties to quantitatively image e ngrafted cells, unambiguous contrast, \nadverse effects on cell biology, limitations for longitudinal follow-up or the lack \nof functional information. Such shortcomi ngs are traditionally overcome in pre-\nclinical research by combining MRI with other imaging modalities like \nbioluminescence imaging or positron emission tomography. Our research \nfocuses on the optimisation of cell labeling strategies for robust, sensitive and \npotentially quantitative vi sualisation of stem and progenitor cells in therapy \nmodels in vivo to assess cell behavior after engraftment. The sensitivity, \nstability, toxicity and adverse effects on the cell biology by the labeling \nprocedure were studied for iron oxide base d particles. The potential of Gd-\nchelates and \n19F labeled compounds for cell labeling has been assessed in \nvitro and in vivo. Based on our preclin ical research finding the potential of \nfuture applications in patients will be explored.  \nDiscussion  17:20\n\nA B C D E F G S113  \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n\u0010\u001e\u001d\u0016\u0014#\u0002\u0001\u0010\u0014\u001f\u0015\u0019\u0001\u0005\u0004\u0001\n\nA B C D E F G S114  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n08:30 - 10:00 Room A  \nInteractive Teaching Session  \nE³ 1620  \nPitfalls in heart imaging  \nA-512 08:30 \nA. CT  \nG. Bastarrika; Toronto, ON/CA (bastarrika@unav.es) \nCardiac CT is becoming the imaging modality of choice for an increasing \nnumber of clinical indications, not only to rule out coronary artery disease but \nalso to evaluate cardiac morphology and function, and to determine patient \noutcome after coronary artery revascularisation. However, as with any other \nimaging tools, appropriate interpretation of cardiac CT examinations is required \nto assess the clinical value of this newly established diagnostic imaging \nmodality. This process requires performance of thorough cardiac CT \nacquisition protocols, detailed knowle dge of standard cardiac anatomic and \nphysiologic terminology, as well as appropriate postprocessing, reading and \nreporting. In particular, radiologists need to recognise and be aware of the \nimaging findings that may confound and lead to interpretation errors. This \nlecture will summarise the practical aspects of postprocessing, reading and \nreporting of non-invasive cardiac CT examinations. The value and limitations of \nevery available CT postprocessing technique including two-dimensional \nmultiplanar reformations, curved multiplanar reformats, maximum intensity \nprojection (MIP) and volume rendered images will be explained. Moreover, \nhints for improving reading results by re cognising technical causes for various \nartefacts in cardiac CT will be elucidated and reading approaches to diminish \nfalse positives, false negatives and inaccuracies when assessing coronary \nartery stenosis will be suggested.  \nLearning Objectives:\n1. To learn about practical aspects of post-processing, reading and reporting \nnon-invasive cardiac CT examinations. \n2. To learn how to improve reading of results by recognising technical causes \nfor various artefacts in cardiac CT. \n3. To become familiar with approaches to reducing inaccuracies and \nmisinterpretations when assessing coronary artery stenosis. \nA-513 09:15 \nB. MRI  \nM. Francone; Rome/IT (marco.francone@uniroma1.it) \nCardiac magnetic resonance (CMR) is a complex imaging technique due to the \nintrinsic anatomical and technical peculiari ties of the exam. These include the \nnon-orthogonal cardiac orientation within  the chest cavity requiring dedicated \nacquisition planes and the complex respiratory and cardiac motion to which the \nheart is subject and requiring a combination of ECG-gated and breath-hold \nsequences. Potential additional anatomic al pitfalls also include normal \nstructures and variants like the moderator band, papillary muscles, and the \npresence of prominent crista terminalis or myocardial trabeculations, whose \nrecognition is mandatory and may mimic in some cases a pathological \ncondition. Technical issues of CMR concer n the continuous intracavitary inflow \nof protons and the associated \"slow-flow\" artifacts (limiting visualisation of \nendomyocardial border in some cases) pitfalls related to ECG gating, like \ninadequate synchronisation or the T-wave swell phenomenon; and finally a \nseries of specific artifacts intrinsically related to the use of different pulse \nsequences that may interfere with image quality. An additional, more complex \nissue to consider is also the widespre ad diffusion of high-field magnets which \nhave further enhanced those aspects. Knowledge of the spectrum of those \nCMR peculiarities is mandatory to approaching and providing a correct \ndiagnosis according to the main clinical request. The present lecture will review \nthe most important anatomical and techni cal pitfalls of CMR examination and \noffer, when possible, practical solutions to overcome those limitations.  \nLearning Objectives:\n1. To learn about common pitfalls in MRI evaluation of the heart. \n2. To become familiar with cardiac anatomical variants potentially mimicking \ndisease. \nAuthor Disclosure:\n M. Francone: Speaker; Bracco Medical Imaging. \n08:30 - 10:00 Room B  \nSpecial Focus Session \nSF 16a  \nShoulder imaging and intervention  \nA-514 08:30 \nChairman's introduction  \nI. Beggs; Edinburgh/UK (ian.beggs@luht.scot.nhs.uk) \nShoulder imaging and intervention are becoming increasingly important in \nclinical practice. This session conside rs the indications, techniques, imaging \nfindings and relative merits of diagnostic ultrasound and MRI of the shoulder. \nThe indications, techniques and results of US-guided interventional procedures \nare also considered. A panel discussion will deal with controversies in shoulder \nimaging such as the accuracy of US and MRI in assessing rotator cuff tears, \ntendinosis, impingement and muscle atrophy, and the efficacy of US-guided \ninterventions. Audience participation in the discussion will be welcome.  \nSession Objectives: \n1. To learn how to perform US and MRI of the rotator cuff. \n2. To appreciate the advantages and limitations of both techniques. \n3. To become familiar with US-guided interventions of the shoulder. \nA-515 08:35 \nUS of the rotator cuff  \nA. Plagou; Athens/GR (athena.plagou@gmail.com) \nThe shoulder is an anatomic area that is very commonly evaluated with \nmusculoskeletal ultrasound. Ultrasonography is widely recognised as a reliable \nmeans of assessing rotator cuff disease with accuracies reaching 100% for full-\nthickness tears and 90-95 % for partial-thickness tears. Diagnostic accuracy \ndepends mostly on the skills and experience of the examiner. A \ncomprehensive ultrasound (US) exami nation requires, first of all, sound \nknowledge of the anatomy. A specific scanning protocol must be adopted in \nevery US examination in patients with shoulder disease, because focal \nsymptoms do not correlate with the location of the disease. The greatest \nimportance of ultrasonography in rotator cuff assessment lies in its dynamic \ncharacter. Several dynamic manoeuvres can reveal pathologies such as \nsubacromial impingement. Last, but not l east there are several scanning pitfalls \nsuch as anisotropy. Anatomy key structures as well as the US technique and \nscanning protocol will be presented in this lecture. Dynamic manoeuvres will \nbe described and demonstrated with videos. Scanning pitfalls will be \nemphasised. Advantages and disadvantages of the US examination compared \nto other imaging modalities will be discussed.  \nLearning Objectives:\n1. To understand the indications for ultrasound in rotator cuff disease. \n2. To appreciate the dynamic aspect of ultrasound and its diagnostic \nimportance. \n3. To become familiar with the ultrasound examination protocol. \n\nA B C D E F G S115  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-516 08:58 \nMRI of the rotator cuff  \nS. Waldt; Munich/DE (Waldt@roe.med.tum.de) \nGuidelines concerning the MR examination technique of the rotator cuff will be \npresented in this session. On intermediate-weighted MR images, tendinopathy \nand partial and complete tears of the rotator can be differentiated with high \ndiagnostic accuracy. Indications for MR arthrography, especially for the \ndetection of small articular sided partial tears in athletes, will be presented as \nwell. Established classification systems for the description of rotator cuff tears \nwill be discussed. Besides characterisation of rotator cuff lesions, especially in \nview of therapeutic decision-making, recognition of the underlying \npathomechanism is necessary. Therefore, the role of imaging is to detect \ndifferent structural findings that are suggestive of a possibly underlying \nimpingement syndrome. In primary impingement syndromes imaging \nabnormalities of the rotator cuff, the overlying bursa and the coracohumeral \narch represent the centre of imaging findings. Primary extrinsic impingement is \ncaused by structural abnormalities of the coracoacromial arch, whereas \nsecondary extrinsic impingement is related to glenohumeral instability. Types \nof internal impingement (posterosuperior and anterosuperior impingement) are \nsecondary to rotator cuff and/or capsular dysfunction. Posterosuperior \nimpingement can be diagnosed on MR arthro grams by identification of the so-\ncalled \"kissing lesion\" pattern, with corresponding lesions of the undersurface \nof the rotator cuff, posterosuperior labrum, greater tuberosity and superior \nglenoid. Imaging abnormalities of this condition will be discussed.  \nLearning Objectives:\n1. To become familiar with MR imaging features of rotator cuff tears. \n2. To learn about an optimised MR imaging protocol for the diagnosis of rotator \ncuff tears. \n3. To understand basic pathomechanisms and MR classification systems for \ncategorising rotator cuff tears. \nA-517 09:21 \nUS-guided interventions of the shoulder  \nL.M. Sconfienza; San Donato Milanese/IT (io@lucasconfienza.it) \nThe shoulder is one of the joints in the human body that is most subject to a \nnumber of pathologic conditions, both in young and in elderly subjects, such as \nsubacromial-subdeltoid bursitis, calcific tendinopathy, and degenerative \nconditions. Being inexpensive, readily available, and radiation-free, ultrasound \nis the imaging modality of choice to guide interventional procedures around the \nshoulder. Thanks to its high resolution and multiplanar capabilities, ultrasound \ncan be used to guide needles precisely in the tendons of the rotator cuff or \nwithin the joint space, both gleno-humeral and acromio-clavicular. This \napproach can be used to perform a number of different procedures. When \ndealing with bursitis, a needle can be guided within the subacromial bursa to \naspirate fluid and to inject anti-inflammatory drugs. In case of calcific \ntendinopathy, one or two needles can be used to dissolve calcium deposit and \ndrain it, providing patients prompt relief. In selected patients with overuse \ntendinopathy, ultrasound can be used to guide intratendinous injection of \nplatelet-rich plasma that has been reported to be helpful in stimulating tendon \nhealing. Although minimally invasive, these procedures should be performed in \nan ultrasound ward with a high degree of sterility, as risk of infection can be \nconcrete.  \nLearning Objectives:\n1. To become familiar with US-guided interventional techniques for the \nshoulder. \n2. To understand the indications for interventions. \n3. To appreciate the types and doses of therapeutic agents. \nPanel discussion:  \nControversies and confusion in shoulder imaging  \n09:44\n08:30 - 10:00 Room C  \nModern Imaging of the GI Tract  \nCC 1621  \nOesophageal and gastric cancer  \nModerator:  \nW. Schima; Vienna/AT \nA-518 08:30 \nA. Modern imaging: an update  \nA. Ba-Ssalamah; Vienna/AT (ahmed.ba-ssalamah@meduniwien.ac.at) \nMulti-detector computed tomography (CT) offers new opportunities in the \nimaging of the gastrointestinal tract. Its ability to cover a large volume in a very \nshort scan time, and in a single breath-hold with thin collimation and isotropic \nvoxels, allows the imaging of the entire oesophagus, stomach, and the whole \nchest and abdomen with high-quality multiplanar reformation and three-\ndimensional reconstruction. Preparation of the patients by fasting from solid \nfood approximately 6 hours prior the examination is important. Proper \ndistention of the oesophagus and stomach by oral administration of \neffervescent granules and water, and optimally timed administration of \nintravenous contrast material are required to detect and characterise the \ndisease. Preoperative staging of oeso phageal and gastric carcinoma appears \nto be the main indication for MDCT and may replace endoluminal ultrasound \n(EUS) in the staging of advanced cancers. The use of various reconstruction \ntechniques, including virtual gastroscopy  (VG) using a volume-rendering (VR) \ntechnique, is promising for the detection of early gastric cancer. The \napplication of the texture analysis technique to distinguish between the \ndifferent types of gastric and esophageal tumors is still evolving. Finally, the \nintroduction of FDG PET, in combination with MDCT, has resulted in further \noptimisation of the diagnostic workup of oesophageal cancer, as well as \nspecific types of cases of gastric cancer. By providing morphologic and \nfunctional information in the same setting, this technique has come to be the \nmodality of choice, when available.  \nLearning Objectives:\n1. To learn about the appropriate use of modern imaging techniques in the \nstaging of oesophageal and gastric cancer. \n2. To become familiar with optimised imaging acquisition protocols, including \npatient preparation. \n3. To appreciate the use of emerging visua lisation techniques, including virtual \ngastroscopy. \nA-519 08:50 \nB. How to provide the perfect staging report  \nR.M. Mendelson; Perth/AU (richard.mendelson@health.wa.gov.au) \nThe diagnosis of oesophageal and gastric cancer is usually based on \nendoscopic findings accompanied by biopsy. However, staging is a matter for \ndiagnostic imaging and is the major determinant of disease management. This \nshould be discussed within a multidisciplinary forum (multidisciplinary team \n[MDT] meeting) in which the radiologist plays a crucial part. Accurate staging - \nusually based on the TNM staging criteria - is essential and the radiologist's \nreport should reflect this pivotal role. The TNM staging of oesophageal cancer \nand gastric cancer will be discussed in detail. The phases in staging is \nessentially a filtering process which seeks to initially exclude distant metastasis \nand/or advanced local disease, initially by optimally protocolled CT scanning, If \nCT shows advanced disease, treatment is palliative, but even under these \ncircumstances imaging will help determine the method of palliation. \nConversely, if CT demonstrates localised disease, 18 F FDG-PET scanning for \noesophageal cancer and for selected cases of gastric cancer is indicated. If \nthis, too, shows no nodal or distant metastasis, accurate T staging with EUS \nwill help determine whether the patient proceeds directly to surgery or \nundergoes neo-adjuvant chemo/radiotherapy prior to surgery, or in the case of \noesophageal cancer may be suitable for EMR. The role of staging laparoscopy \nin gastric cancer will also be discussed. In summary, the radiologist and \nnuclear medicine physician are crucial in determining treatment. Their reports \nare lynch pins in the MDT discussion of patient management. It is therefore \nessential that the imaging report should optimally inform this discussion.  \nLearning Objectives:\n1. To learn about the latest TMN staging in oesophageal and gastric cancer. \n2. To appreciate the imaging criteria for local, nodal and metastatic disease, \nand understand the accuracy of imaging staging. \n3. To become familiar with the structure of a perfect imaging report. \nA-520 09:10 \nC. Assessment after treatment  \nA.M. Riddell; London/UK (Angela.Riddell@rmh.nhs.uk) \nIt is now established that for the majority of patients with oesophageal and \nadvanced gastric cancer, there is survival benefit from the use of neoadjuvant \ntherapy. Therefore, there is a requirement for imaging to accurately restage the \ntumour and to assess the response to neoadjuvant therapy, to provide \nprognostic information and to direct future management. Restaging following \ntherapy is challenging, as differentiating treatment-related fibrosis/oedema \nfrom viable tumour is problematic with both CT and endoscopic ultrasound. \nThe T and N staging accuracy for both modalities falls following neoadjuvant \ntherapy. Inconsistencies in measurements due to alterations in the degree of \ngastric/oesophageal distension can also  limit the accuracy of RECIST criteria \nto determine the response. Functional imaging techniques such as PET-CT \noffer an improved method for assessing response. Alterations in the \nStandardised Uptake Value (SUV) occur much earlier than changes in size; \ntherefore a metabolic response can be detected sooner, allowing for more \nrapid alterations in treatment strategies. Acute complications following \noesophagogastrectomy generally occur within the thorax and are either related \nto a leak at the anastomosis/mediastinitis or respiratory complications such as \npneumonia or a pleural effusion. Intra-abdominal collections may develop \n\nA B C D E F G S116  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nfollowing oesophagogastrectomy and gastrectomy. Late complications \nfollowing both procedures are often due to tumour recurrence: locoregional \nsuch as lymph node recurrence or at the anastomosis; metastatic spread such \nas haematogenous spread or via the peritoneum or pleura. Currently, there is \nno consensus on the most appropriate timing or frequency of postoperative \nimaging.  \nLearning Objectives:\n1. To understand the role of imaging in treatment response assessment. \n2. To appreciate the imaging signs of viable or recurrent tumour after therapy. \n3. To learn about the common surgical procedures and potential pitfalls in \ninterpreting postoperative imaging. \nA-521 09:30 \nD. Interactive case discussion  \nW. Schima; Vienna/AT \n08:30 - 10:00 Room D  \nChest  \nRC 1604  \nPulmonary arterial hypertension  \nModerator:  \nA.P. Parkar; Bergen/NO \nA-522 08:30 \nA. An overview of pulmonary artery hypertension  \nN.J. Screaton; Cambridge/UK (Nicholas.Screaton@papworth.nhs.uk) \nPulmonary hypertension is defined by increased mean pulmonary arterial \npressure > 25 mmHg at rest or > 30 mmHg during exercise. PH causes \nsignificant mortality and morbidity, but commonly presents with non-specific \nclinical signs and symptoms resulting in significant delay in accurate diagnosis \nand specific treatment. Untreated PH is progressive with increased pulmonary \nvascular resistance leading to right ventri cular failure and ultimately death. The \ncurrent Dana Point classification of pulmonary hypertension is clinically based. \nIt groups diseases with similar pathophysiological mechanisms and therapeutic \napproaches. Groupings include conditions characterised by diffuse small \nvessel narrowing (Group 1 and Group 1'), PH secondary to left sided cardiac \ndisease (Group 2), chronic hypoxic pleuro-parenchymal disease (Group 3), \nchronic thrombo-embolic pulmonary hypertension CTEPH (Group 4), and a \nmiscellaneous group of diseases with either unclear or multi-factorial \naetiologies (Group 5). In the Dana Point classification, small vessel diseases \nare subdivided into Group 1 which primarily  affect the pulmonary arterioles and \nGroup 1' affecting the capillary/venous pulmonary circulation (pulmonary \ncapillary haemangiomatosis and pulmonary veno-occlusive disease). The \ndifferentiation of Group 1 from Group 1' diseases is important since in group 1' \narteriolar dilatation treatments can cause life-threatening pulmonary oedema. \nGroup 4 is synonymous with CTEPH with other causes of large vessel \nobstruction (vasculitis and pulmonary artery tumour) being considered as \nGroup 5 disorders. Recent advances include an increased understanding of \nmolecular mechanisms underpinning PAH, facilitating targeted therapy \ndevelopment, a rapidly expanding role of surgical pulmonary endarterectomy in \nproximal CTEPH, and recognition of imaging as a potential therapeutic end \npoint.  \nLearning Objectives:\n1. To learn about the epidemiology of pulmonary artery hypertension. \n2. To become familiar with the clinical symptoms, signs and causes of \npulmonary artery hypertension. \n3. To appreciate the importance of and difficulties in treating pulmonary artery \nhypertension. \nA-523 09:00 \nB. CT in pulmonary artery hypertension  \nM.-P. Revel; Paris/FR (marie-pierre.revel@htd.aphp.fr) \nCT allows depicting pulmonary hypertension (PH) and helps identifying its \ncause, therefore playing a crucial role in the diagnostic workup. CT features of \npulmonary arterial hypertension include dilatation of the pulmonary artery \ntrunk, with a diameter greater than or equal to 29 mm, a ratio to the aortic \ndiameter greater than 1:1 and a segmental artery-to-bronchus ratio greater \nthan 1:1 in at least three pulmonary lobes. On ECG-gated CT, right pulmonary \nartery distensibility shows the best diagnostic value with 86% sensitivity and \n96% specificity for a cutoff value of 16.5%. Among the various causes of \nsecondary PH, CT is especially useful for detecting signs of chronic \nthromboembolic pulmonary hypertension, including wall-adherent thrombi, \nbands, webs or chronic arterial occlusion, mosaic lung attenuation and \nsystemic collateral supply. CT shows signs of pulmonary edema, such as \nthickening of the interlobular septa, centrilobular ground glass opacities, \nmediastinal lymph node enlargement and pleural effusion in PH caused by \npulmonary veno-occlusive disease, left  heart diseases or mediastinal fibrosis. \nSigns of lung parenchyma diseases may be indentified on CT; PH is a late \ncomplication in patients with pulmonar y fibrosis, sarcoidosis or chronic \nobstructive lung disease, but may affect systemic sclerosis patients with limited \nlung parenchyma involvement. Congenital cardiac abnormalities with untreated \nright-to-left shunting resulting in Eisenmenger syndrome, such as ventricular or \natrial septal defect and patent ductus art eriosus are easily recognised on CT. \nConversely, signs of peripheral pulmonary arteriovenous shunting in \nportopulmonary hypertension and PH caused by hepatopulmonary syndrome \nare more difficult to assess.  \nLearning Objectives:\n1. To learn about the CT diagnosis of pulmonary artery hypertension. \n2. To become familiar with the causes of pulmonary artery hypertension on CT. \nA-524 09:30 \nC. MRI in pulmonary artery hypertension  \nJ. Biederer; Heidelberg/DE (Juergen.Biederer@med.uni-heidelberg.de) \nFor the assessment of pulmonary arterial hypertension (PAH), the dedicated \n30 min MRI protocol would comprise a free breathing and noncontrast-\nenhanced examination, short T2-w sequences, dynamic contrast-enhanced \nperfusion imaging, a high-resolution angiogram, a 3D breath-hold acquisition, \ndynamic steady-state free precession or gradient echo sequences of the heart \nand a study of myocardial late enhancement. The morphologic sequences \nshow typical features of PAH: right atrial/ventricular dilatation, enlargement of \nthe pulmonary trunk/main pulmonary arteries and peripherally attenuated \npulmonary vessels. Incidental infiltrates, nodules or masses of the lung, \nmediastinum and chest wall would be covered. The first pass contrast-\nenhanced perfusion imaging demonstrates an increased mean transit \ntime/decreased pulmonary blood flow, but a relatively homogeneous lung \nperfusion (important to differentiate from CTEPH, where multiple segmental \nperfusion defects would be expected). The cardiac part shows right ventricular \nmass, wall thickness and functional changes correlating with elevation of \npulmonary arterial pressure: distortion of the interventricular septum, area \nchange of the pulmonary trunk, right ventricular volume/stroke volume as well \nas pathologic right/left ventricular end-diastolic volume indexes. Late \nenhancement of the right ventricular wall would correlate with myocardial \nfibrosis. Furthermore, optional ex perimental velocity-encoded sequences \n(ideally for multidirectional flow vis ualisation, \"4D flow\") show a decreased \npulmonary artery blood flow velocity, increased retrograde flow and \ninhomogeneous velocity profiles. In concl usion for the near future, given the \navailability of scanner time and appropriate experience of the team, thoracic \nMRI is probably the most comprehensive and effective single examination for \nthe diagnosis and follow-up of PAH.  \nLearning Objectives:\n1. To learn about the MRI diagnosis of pulmonary artery hypertension. \n2. To appreciate the role of MRI in the assessment of pulmonary artery \nhypertension. \n3. To become familiar with MRI techniques in the assessment of pulmonary \nartery hypertension. \nAuthor Disclosure:\n J. Biederer: Equipment Support Recipient; Siemens. Speaker; Siemens. \n08:30 - 10:00 Board Room B  \nSpecial Focus Session  \nSF 16b  \nMultisystemic malignancies in organ-\nbased radiology  \nA-525 08:30 \nChairmen's introduction  \nI.E. Tyurin1, H. von Tengg-Kobligk2; 1Moscow/RU, 2Berne/CH \nIn the era of organ-based radiology, the group of diseases known as \nmultisystemic malignancies represents an obvious challenge to both \nradiologists and oncologists. The necessity to match the growing possibilities \nof different imaging modalities with widespread multisystemic pathology and \nclinical sufficiency resulted in upgrad ing well-known diagnostic algorithms. The \nprecise knowledge of clinical staging systems and classification, and the \npathologic and physiologic mechanisms of the disease pathways are important \nfor planning imaging modalities and specific protocols. Perfect imaging of \nmultisystemic malignancies now includes not only traditional anatomic-based \nmodalities, but also much more often different types of whole body scanning \nsuch as CT, MRI, PET and their combination in SPECT/CT, PET/CT and now \neven PET/MRI. New imaging modalities and growing possibilities of traditional \nimaging techniques obviously influence the current clinical guidelines for this \n\nA B C D E F G S117  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\npathology. Finally, the perfect assessment of cl inical course of the disease and \npossible outcomes, the understanding of tumor response criteria and therapy-\ninduced changes are significant for image interpretation in patients with \nmultisystemic malignancies.  \nSession Objectives: \n1. To appreciate the complexity of the clinical management of patients with \nmultisystemic malignant diseases. \n2. To learn about the potential of whole-body CT and MRI, including pitfalls and \nlimitations. \n3. To become familiar with the clinical role of PET/CT and MR/PET, including \nradiotracers. \nA-526 08:35 \nMultiple myeloma  \nM.-A. Weber; Heidelberg/DE (MarcAndre.Weber@med.uni-heidelberg.de) \nMultiple myeloma is a haematologic disorder characterised by the infiltration \nand proliferation of monoclonal plasma cells mainly in the bone marrow. The \nmain symptoms are hypercalcaemia, renal impairment, cytopaenia/anaemia \nand bone disease - summarised as CRAB-criteria. Symptomatic multiple \nmyeloma is consistently preceded by asymptomatic premalignant stages called \nmonoclonal gammopathy of undetermined significance and smoldering multiple \nmyeloma. These stages also present with detectable monoclonal protein \nand/or monoclonal plasma cells in bone marrow, but do not show any end \norgan impairment. Staging of multiple myeloma is based on the measurement \nof the monoclonal protein in serum and urine as well as the assessment of \nimpairment of haematopoiesis, renal function and mineralised bone. In the last \ndecade, the development of novel therapeutic agents has led to an increase in \nresponse rates and survival time of patients with multiple myeloma, which \nfurther stresses the value of response assessment by imaging. Cross-sectional \nimaging like MRI, CT and PET-CT is currently replacing conventional \nradiological surveys in the initial workup and follow-up of patients with \nmonoclonal plasma cell diseases. Recent studies demonstrate the added value \nof MRI in improving initial staging by unravelling a diffuse infiltration of bone \nmarrow by plasma cells, a focal pattern or a combination of both. Also, PET-CT \ncan detect response to therapy earlier than conventional response criteria. \nFurthermore, recent studies revealed that a complete remission of myeloma \nconfirmed by MRI or PET-CT goes along with a better prognosis compared to a \ncomplete response based only on serological parameters.  \nLearning Objectives:\n1. To learn about the role of clinical staging systems and imaging in work-up \nand classification of plasma cell disorders with a focus on multiple myeloma \nand to learn about parameters of disease activity. \n2. To understand the pathophysiologic mechanisms of multiple myeloma and \nto learn about the effects of abnormal plasma cells on bone remodeling cells. \n3. To become familiar with response criteria and therapy-induced changes and \nto compare the significance of imaging and serological markers for response \nevaluation in multiple myeloma. \n4. To learn about recent studies on imaging based response assessment and \nprognostic significance. \nA-527 08:58 \nLymphoma  \nA. Mikhaylov; Moscow/RU (azatmihailov@gmail.com) \nOver the last 40 years, there have been numerous efforts to classify lymphoid \nmalignancies, culminating in the WHO classifi cation introduced in 2008. So it is \nclear that malignant lymphomas require a sophisticated diagnostic approach \nbased on clinical features, morphology, immunophenotyping and genetic \nanalysis. It is essential that such an  approach underpins the clinical \nmanagement of these diseases, many of which are amenable to cure. The \nsame situation is present in radiology staging procedures - it has a multi-\ndisciplinary approach. A wide range of staging procedures can include all \nradiology methods from CXR and chest and abdominopelvic computed \ntomograph to whole body MRI, scintigraphy and PET-CT scans.  \nLearning Objectives:\n1. To learn about the current classification and staging of lymphomas. \n2. To become familiar with classic imaging patterns of lymphomas. \n3. To understand the role of imaging in the follow-up of lymphoma patients. \nA-528 09:21 \nMelanoma  \nM.A. Fischer; Zurich/CH \nMalignant melanoma (MM) originates from the melanocytes of the basal layer \nof the epidermis showing a rising incidence and high mortality in the white, \nWestern population. Risk factors of melanomagenesis like sun exposure are \nwell known and early detection with surgical resection of MM is essential for \npatient prognosis. Staging of MM is based on tumour thickness, ulceration, \nlymph node and distant metastases. Lymph flow and chemotaxis are thought \nto be responsible for the homing of MM ce lls, resulting in satellite or in-transit \nlesions of the regional lymph node system. Distant spread of MM is thought to \ntranspire intra- and extravascularly  (along the external vessel lattices) \nsupported by specific mechanisms of extravasation and protection of MM cells \nagainst the local immune system. To date, many imaging methods, such as \nultrasound, computed tomography (CT), magnetic resonance imaging, and \npositron emission tomography/CT, are used in the diagnosis of MM and its \nmetastases, whereas lymphoscintigraphy has become an important tool for \nworkup of the lymph node drainage patterns. Radiological challenges include \nimproved staging and re-staging of multi-systemic MM. Accordingly, current \nimaging guidelines and the role and applications of the different imaging \nmodalities in advanced MM (stage III / IV) are reviewed with regard to their \nusefulness in patient management. However, standardised imaging protocols \nand integration of functional information to morphological imaging are needed \nin the future to allow for improved detection and guidance of treatment in \npatients with MM.  \nLearning Objectives:\n1. To learn about the prognosis factors of melanoma. \n2. To understand the metastatic pathways and time course of melanoma. \n3. To become familiar with imaging guidelines in cutaneous melanoma. \nPanel discussion:  \nWhat is the role of imaging in the staging of malignancies?  \n09:44\n08:30 - 10:00 Room E1  \nAbdominal Viscera  \nRC 1601  \nPancreatic inflammation  \nModerator:  \nR.J. Méndez; Madrid/ES \nA-529 08:30 \nA. Acute pancreatitis  \nM. Zins; Paris/FR (mzins@hpsj.fr) \nThe original Atlanta Classification of acute pancreatitis established in 1992 is \noutdated. In 2012, an international working group has modified the Atlanta \nClassification for acute pancreatitis to update the terminology and provide new \nmorphologic classifications.The revised classification of acute pancreatitis \nidentified two phases of the disease: early (first week) and late (after the first \nweek). Acute pancreatitis is subdivided into two types: interstitial oedematous \npancreatitis and necrotising pancreatitis. If the diagnosis of acute pancreatitis \nis established by abdominal pain and by increases in the serum pancreatic \nenzyme activities, a contrast-enhanced CT is not usually required for diagnosis \nin the early phase. This revised classification introduces new terminology for \npancreatic fluid collections. Depending on the presence or absence of \nnecrosis, acute collections in the first 4 weeks are called acute necrotic \ncollections or acute peripancreatic fl uid collections. Once an enhancing \ncapsule develops, persistent acute peripancre atic fluid collections are referred \nto as pseudocysts and acute necrotic collections, as walled-off necroses. All \ncan be sterile or infected. This classification of acute pancreatitis allows a \nconsistent, worldwide classification and should avoid confusion in the \nterminology of pancreatic fluid collections.  \nLearning Objectives:\n1. To learn how imaging should be scheduled for patients with acute \npancreatitis. \n2. To become familiar with the imaging features and the terminology proposed \nin the Atlanta classification. \nA-530 09:00 \nB. Chronic pancreatitis and IPMN  \nC. Matos; Brussels/BE (cmatos@ulb.ac.be) \nThe role of diagnostic imaging in chronic and inflammatory pancreatitis and \nIPMNs is to detect structural changes of the ducts and of pancreatic \nparenchyma, assess the functional integrity of the gland, detect associated \ncomplications, and assist in management. These goals are generally fully \nachieved using MDCT and MR imaging. In this lecture, the advantages and \nlimitations of each technique will be discussed and illustrated. Key features \nallowing differential diagnosis of both entities will be underlined.  \nLearning Objectives:\n1. To learn the classical aspect of IPMN on imaging. \n2. To learn how it merges with chronic pancreatic disease and how can we \ndifferentiate both. \n3. To understand the role of different imaging techniques in assessing both \ndiseases. \n\nA B C D E F G S118  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-531 09:30 \nC. Paraduodenal and autoimmune pancreatitis  \nS.A. Jackson; Plymouth/UK (simon.jackson1@nhs.net) \nAutoimmune pancreatitis (AIP) was first described in 1961 and represents a \nrare form of immune mediated chronic pancreatitis which is characterised by a \nmarked infiltration of lymphocytes and plasma cells into pancreatic tissue. \nWhilst the majority of cases present with diffuse gland involvement, \napproximately 30% of patients demonstrate either segmental or focal \ninvolvement of the pancreas. Clinical presentation is very variable with patients \ndescribing a range of symptoms; severe pain however is uncommon. Imaging \nplays a central role in the diagnosis and management of AIP and knowledge of \nthe radiological appearances, which can vary significantly due to the various \ndegrees of fibrosis and inflammatory infiltrate, is critical. Cardinal features \ninclude focal or diffuse pancreatic enlargement with the loss of normal lobular \narchitecture. In addition, pancreatic duct involvement as demonstrated by \nsingle or multiple focal strictures with limited more proximal dilatation is \ncommon. Whilst these appearances may suggest a diagnosis of AIP \ncorrelation with clinical history, serology and histopathology is mandatory to \naccurately diagnose atypical cases. In contrast, paraduodenal pancreatitis is a \nspecific and rare form of segmental chronic inflammation characterised by \nfibrous tissue formation in the \"groove\" area between the duodenum, head of \npancreas and lower common bile duct. The pathology was first described in \n1973 and has since been subdivided into pure, segmental and non-segmental \nforms. Whilst the radiological diagnosis of both AIP and paraduodenal \npancreatitis remains challenging, the presentation will emphasise relevant \nimaging strategies as well as provide tips and tricks for accurate diagnosis.  \nLearning Objectives:\n1. To become familiar with the clinical presentation and the radiological signs \nthat may be observed in autoimmune pancreatitis. \n2. To become familiar with the diagnostic criteria for the disease. \n3. To learn about the strategies for managing doubtful clinical situations. \n08:30 - 10:00 Room E2  \nOncologic Imaging  \nRC 1616  \nManagement of bone metastases  \nA-532 08:30 \nChairman's introduction  \nH. Ahlström; Uppsala/SE (hakan.ahlstrom@radiol.uu.se) \nBone scintigraphy is often used in combination with CT and clinical information \nfor staging and therapy response evaluation of bone metastases. Magnetic \nresonance (MR) imaging is a technique that is known to be valuable both for \ndetection of bone metastases and for evaluation of their response to treatment. \nIntegrated positron emission tomography with computed tomography (PET/CT) \ncombines the functional data from PET with anatomic information of CT in a \nsingle examination. 18 F-fluo ride is a non-specific PET tracer that has recently \nshown very high sensitivity for bone metastases. For accurate response \nevaluation, it is important to recognise not only changes in bone metastases, \nbut also the effects of treatment on unaffected, normal parts of the bone \nmarrow. These latter therapy-related benign changes could otherwise be \nmisinterpreted as disseminated disease or vice versa. Despite the fact that the \nmethods mentioned above, alone or in combination, have improved the \nassessment of bone metastases, they often remain non-specific. A specific \ndiagnosis can in many cases only be achieved with a bone biopsy. This \nrefresher course will give you an overview of the present imaging methods for \ndetection and characterisation of bone le sions. Indications for, and how to \nperform, ablation and cementoplasty of bone metastases will be presented. \nOptimal algorithms for treatment follow-up of bone metastases and advantages \nand disadvantages with different imaging methods will be reviewed. Also, \nfuture development of diagnostic and therapeutic methods will be included in \nthe presentations, e.g. potential role of emerging PET imaging probes for \nassessing bone malignancies.  \nAuthor Disclosure:\nH. Ahlström: Research/Grant Support; Astrazeneca. \nA-533 08:35 \nA. Diagnostic approach: the role of hybrid imaging  \nK. Herrmann; Würzburg/DE (Herrmann_K1@klinik.uni-wuerzburg.de) \nThis presentation will include a short review of the epidemiology of primary and \nmetastatic bone disease, its classification  and staging definitions. Then we \ndiscuss the role of radionuclide imaging in initial and subsequent treatment \nstrategy considerations. Another aim is to provide guidelines for the \nappropriate use and applications of diagnostic radionuclide approaches for the \nassessment of bone diseases. The focus of this presentation will be on the role \nof radionuclide imaging in metastatic prostate, breast and lung cancer in the \ncontext of other available diagnostic imaging approaches. The ability of hybrid \nimaging technologies to achieve improved diagnostic accuracy will be \nemphasised and when appropriate the potential role of emerging PET imaging \nprobes for assessing bone malignancies discussed. If feasible, the availability \nand effectiveness of radionuclide-based therapeutic approaches for malignant \nbone diseases will be reviewed.  \nLearning Objectives:\n1. To learn about the standard MRI pulse sequence protocol for the \nassessment of bone metastases. \n2. To understand the physiological and metabolic tumour properties which can \nbe assessed with different PET tracers. \n3. To become familiar with potential pitfalls and abnormalities that mimic \nmetastases. \nA-534 08:58 \nB. Therapeutic radiological approaches: from ablation to cementoplasty  \nT. De Baere, L. Tselikas, F. Deschamps; Villejuif/FR (debaere@igr.fr) \nBone metastases occur in about 20% of cancer patients and can induce pain \nand/or a pathological fracture. Cementoplasty and percutaneous thermal \nablation techniques (radiofrequency, cryotherapy) can help in pain relief and \nconsolidation. Cementoplasty is mostly performed in vertebral and acetabular \nmetastases (even if other bony structures can be treated) with a clearly \ndemonstrated analgesic effect. The role of cementoplasty versus radiotherapy \nand/or opioid is still debated. The proof of benefit in consolidation of bone by \ncementoplasty is not well demonstrated, and cementoplasty is still inadequate \nin structures subject to high mechanical stresses such as long bones. For such \npurpose, percutaneous deployment of orthopaedic hardware such as \npercutaneous screw fixation has been developed. Last, cementoplasty is not \nan antitumour treatment and cannot therefore be offered as a cure for bone \nmetastasis. Thermal ablation is currently performed for pain palliation of bone \nmetastases, in selected patients, namely in locations difficult to treat with \ncementoplasty. In a subset of bone metastases, thermal ablation can also be \ncurative. Indeed, out of 88 curative intent thermal ablation of 122 bone \nmetastases, the 1-year complete treatment rate was 67% [95%CI: 58%-75%]. \nIn multivariate analysis, the good prognostic factors for complete local \ntreatment were: metachronous bone metastasis (p=0.004), no cortical erosion \n(p=0.01), small metastasis size (p=0.001), no neurological structures in the \nvicinity (p=0.002).  \nLearning Objectives:\n1. To understand the clinical relevance and indications for ablation and \ncementoplasty of bone metastases. \n2. To learn how to perform state-of-the-art ablation and cementoplasty. \n3. To become familiar with possible complications of these interventions. \nA-535 09:21 \nC. Assessment of tumour response: techniques and timing  \nG. Cook; London/UK (Gary.Cook@kcl.ac.uk) \nSkeletal metastases are associated with si gnificant morbidity and have high \nimpact on health costs. Effective palliative treatments are available, but less \nthan 50% of patients respond in terms of tumour markers, pain or quality of life \nand all treatments are associated with some toxicity. It is generally accepted \nthat the current imaging techniques are inadequate for measuring treatment \nresponse in a clinically relevant time frame such that skeletal metastases are \nusually considered as non-measurable dise ase in clinical routine and trials. \nThere is therefore a need for non-invasive, objective methods to evaluate \ntreatment response of skeletal metastases at earlier time points to guide \nclinical care. In addition to imaging structural changes in bone (e.g. X-ray, CT), \nit is now possible to image a number of biological characteristics of bone \nmetastases including tumour metabolism, tumour cellularity, and osteoblast \nand osteoclast activity. Methods currently available, or being actively \ninvestigated, include \n99mTc-MDP SPECT/CT, 18F-fluoride PET/CT, 18F-FDG \nPET/CT, 11C/18F-choline PET/CT, RGD-SPECT/PET and DW-MRI. Some of \nthe tracer methodologies will potentially be applicable for and complementary \nto PET/MRI. The timing of follow-up imaging after commencing treatment is still \nunder investigation. It is likely that tumour-specific methodologies may reflect \nresponse/non-response earlier than bone-specific methods due to a prolonged \nflare in reactive bone in responding metastatic sites.  \nLearning Objectives:\n1. To understand the techniques and quantitative parameters used for \ntreatment response evaluation. \n2. To learn the optimal timing for follow-up imaging after treatment. \n3. To become familiar with common pitfalls in the interpretation of post-\ntreatment MRI and PET. \nPanel discussion:  \nHow to differentiate between bone metastases and chronic inflammatory \nor treatment-induced changes  \n09:44\n\nA B C D E F G S119  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n08:30 - 10:00 Room F1  \nSpecial Focus Session  \nSF 16c  \nStructured reporting  \nA-536 08:30 \nChairman's introduction  \nA. Palko; Szeged/HU (palkoand@gmail.com) \nStructured reporting is an opportunity and a challenge at the same time. Expert \nspeakers of this session will present and discuss their views on the subject, \ncontributing to the clear vision of the members of audience on this complicated \nsubject, convincing us to take this techniqu e as an opportunity to improve and \nstandardise the quality of our reporting activities.  \nSession Objectives: \n1. To become familiar with the concept of structured reporting. \n2. To learn more about the various techniques and technical requirements of \nstructured reporting. \n3. To understand how structured reporting and decision support tools may \nassist the work of radiologists. \nAuthor Disclosure:\n A. Palko: Advisory Board; Euromedic. \nA-537 08:35 \nStructured reporting: from clinical needs to technical challenges  \nM. Fatehi; Tehran/IR (fatehi@irsr.org) \nEven though structured reporting (SR) has been appreciated as one of the \neffective methods of electronic reporting, there are not that many real \napplications to facilitate utilisation of this technique in practice. Why it is so? \nThe radiologists want a flexible tool to create clear, concise reports in a \nreasonably short time. Like all template-based reporting systems, the \napplication must be tailored to preferences of multiple users in a radiology \ndepartment. The report templates should also be flexible in terms of length to \navoid inappropriately detailed reports. The final appearance of the report is \ncritical for acceptance by clinicians. Accor dingly, the technical challenges of \ndevelopment of SR systems may be grouped as: \"user interface\", \"database \nstructure\", and \"output file/document\" problems. Flexibility to comply with \ndifferent user preferences will lead to both user interface design and database \nstructure challenges. One of the major technical challenges is the \ntransformation of structured data to a final text to be acceptable and applicable \nfor the referring physician. Also, exporting of reports to DICOM format using \nDICOM-SR concepts is still a challenge. Multi-media formats are becoming \nmore and more popular specially in SR reports. The purpose of this \npresentation (based on examples from published and personally developed SR \nsolutions) is to follow through the clinical needs of a radiologist to the technical \nchallenges of implementing a clinical-, not a research-, structured reporting \napplication.  \nLearning Objectives:\n1. To become familiar with different approaches to structured reporting. \n2. To understand the technical difficulties of developing a flexible structured \nreporting application. \n3. To learn about structured reporting tools available for radiology practice. \nA-538 08:53 \nStructured reporting in the US  \nC.E. Kahn; Milwaukee, WI/US (kahn@mcw.edu) \nEffective communication of radiology results  is critical to high-quality health \ncare. To that end, the Radiological Society of North America (RSNA) has \ndeveloped a library with more than 200 best-practice radiology reporting \ntemplates. The templates are freely available online (www.radreport.org) and \nhave been accessed more than 750,000 times. The new IHE \"Management of \nRadiology Reporting Templates\" (MRRT) profile builds upon the web's \nHypertext Markup Language version 5 (HTML5) to provide an international \nstandard for describing and exchanging reporting templates. This presentation \nwill describe the RSNA report template library, introduce the international \nMRRT standard for report templates, and describe opportunities for ESR \nmembers and affiliated societies to participate. The broad goals of this initiative \nare to improve the quality of radiology reports, increase the productivity of \nradiologists, promote the use of practice guidelines, and advance data-driven \nhealth care.  \nLearning Objectives:\n1. To explore a library of 'best practices' radiology reporting templates. \n2. To become familiar with international standards for radiology reporting \ntemplates. \n3. To understand how structured reporting will promote the use of practice \nguidelines and will advance data-driven health-care. \nA-539 09:11 \nStructured reporting in Europe: the ESR initiative  \nO. Ratib; Geneva/CH \nThe RSNA has initiated a new initiative called RadReport with the aim of \nhelping promote standard reporting and improve reporting practices by creating \na library of clear and consistent report templates (http://reportingwiki.rsna.org/). \nThis project also supported in part by the National Institute of Biomedical \nImaging and Bioengineering (NIBIB) has already gained the participation of \nnumerous countries around the world, contributing with reports in different \nlanguages. These report templates are \"structured\" in the sense that they \nincorporate reusable knowledge, or meaning, to the clinical reporting process. \nThey are free and not subject to licence restrictions on their reuse. Recently, \nthe ESR eHealth and Informatics Subcommittee has decided to engage in \npromoting this initiative in Europe and supporting its development. Professor \nCharles Kahn from Medical College of Wisconsin, who is an active member of \nthe RSNA working group on standard reporting, has joined the ESR \nsubcommittee to help promote this initiative in Europe as well. There are \nalready over 250 templates and the number of views is increasing every day \n(over 150,000 downloads so far). Most of the templates are in English, but \nthere are several also in Arabic, Chinese, Turkish, Spanish, etc. There is also \ninterest in translating the templates to other languages. In an effort to support \nthis worldwide initiative, the ESR eHealth and Informatics Subcommittee \ndecided to encourage National Societies to contribute to the submission and \ntranslation of templates and participate in the Subspecialty and Allied Sciences \nSocieties to create reporting templates.  \nLearning Objectives:\n1. To review the adoption of structured reporting in Europe. \n2. To understand the challenges and differences in local regulation and \npractices. \n3. To learn about the joint efforts of the ESR with RSNA and how to participate. \nA-540 09:29 \nImplications for radiological practice and decision support tools  \nJ.O. Barentsz; Nijmegen/NL (jelle.barentsz@radboudumc.nl) \nStructured interpretation and reporting for detecting significant prostate cancer \nis crucial, as it allows comparing inter-observer interpretation variability, \nreduces this variability by stimulating discussion of the individual scores, \nenhances communication with the clinicians in a uniform way, facilitates quality \nassurance plus research, and in this way improves patient outcome. In this \npresentation, the PI-RADS scoring system will be shown and discussed, and \nfast effective structured reporting using computer software will be presented.  \nLearning Objectives:\n1. To understand why structured reporting is needed, and what the advantages \nare for clinical care. \n2. To learn how structured reporting should be carried out. \n3. To become familiar with the content of a structured report. \n4. To learn how computer programmes can help. \nAuthor Disclosure:\n J.O. Barentsz: Owner; The Radboudumc department of radiology has CE \napproval of PROCAD software. Other; The Radboudumc department of \nradiology owns and produces Sinerem/Combidex. \nPanel discussion:  \nStructured reporting in the daily practice: friend or foe?  \n09:47\n08:30 - 10:00 Room G/H  \nNeuro  \nRC 1611  \nNeuroimaging in dementia  \nA-541 08:30 \nChairman's introduction  \nF. Barkhof; Amsterdam/NL (f.barkhof@vumc.nl) \nIn a rapidly ageing society, dementia prevalences are sharply increasing. \nFurthermore, knowledge about disease mechanisms is constantly evolving. A \nmore nosologic approach in the workup of dementia is required to improve \nprognostication, patient management as well as select appropriate treatment. \n\nA B C D E F G S120  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nRadiologists will be confronted with a marked increase in the number of \nrequests for imaging. This requires a thorough knowledge of the relevant brain \nanatomy, choice of appropriate structural and molecular imaging modalities \nand interpretation of MRI and PET/SPECT in the most prevalent disorders in a \nstructured fashion.  \nA-542 08:35 \nA. Anatomy of the limbic system  \nT.A. Yousry; London/UK (t.yousry@ucl.ac.uk) \nThe term \"limbic\" has been used in many different connotations. To understand \nthe anatomy, we have to define the term  first. The clearest definition stems \nfrom Broca: \"Le grand lobe limbic\". Defined as such, the limbic lobe is \ncomposed of 2 main structures: the limbic and the intralimbic gyri. 1. The limbic \ngyrus is composed of the subcallosoal gyrus anteriorly, followed in an arc by \nthe cingulate gyrus, isthmus and parahippocampal gyrus. The latter is \ncomposed of 2 parts: i) a posterior narrow segment, the superior surface of \nwhich is called subiculum, and ii) a more voluminous anterior segment, also \nknown as the piriform lobe. The latter consists of the anterior part of the uncus \nand the entorhinal area. 2. The intralimbic gyrus arches within the limbic gyrus. \nIt is divided into 3 parts: i) anterior (prehippocampal rudiment); ii) superior \n(indusium griseum); and iii) inferior (hippocampus). The latter consists of 2 \nlamina rolled inside each other: the cornu ammonis and the dentate gyrus, with \nthe cornu ammonis consisting of 4 neuron al fields (CA1-4). To understand the \nfunction, we have to understand the connections that define this function. The \ninterplay with the insula is of particular importance. In summary, we will review \nthe MRI characteristics of the components of the limbic lobe, their connections, \nand their function, using 1.5 T, 3 T and 9.4 T high field imaging. At the end of \nthis lecture, you will know definition (s) of the limbic lobe, its major \nsubdivisions, connections and functions.  \nLearning Objectives:\n1. To understand the architecture of the limbic system. \n2. To recognise the structure and connections of the hippocampus and medial \ntemporal lobe. \n3. To become familiar with the imaging characteristics at various field strengths \nand pulse-sequences. \nAuthor Disclosure:\n T.A. Yousry: Advisory Board; Biogen Idec. Author; T Yousry. Research/Grant \nSupport; UCL/UCLH Biomedical Research Centre, GlaxoSmithKline, MS \nSociety of Great Britain and Northern Ireland, MRC, Wellcome Trust, Stroke \nAssociation, British Heart Foundation, Novartis, Biogen Idec. Speaker; ESOR, \nKing Abdullah Medical City. \nA-543 08:58 \nB. Structural MRI and CT: beyond exclusion  \nM.P. Wattjes; Amsterdam/NL (m.wattjes@vumc.nl) \nStructural neuroimaging is increa singly used in the diagnosis of \nneurodegenerative diseases. In a memory clinic setting, computed tomography \n(CT) and magnetic resonance imaging (MRI) have become the most important \nparaclinical diagnostic tools. Rece nt guidelines on the diagnosis and \nmanagement of disorders associated with dementia state that neuroimaging \nshould be performed at least once during the diagnostic workup. In the past, \nneuroimaging had been performed to exclude potentially treatable causes of \ndementia. However, this exclusionary approach of neuroimaging in the \ndiagnosis of dementia has been replaced by an inclusionary approach driven \nby conclusive evidence that CT and MRI can substantially support the clinical \ndiagnosis by the demonstration of a distinct atrophy pattern and the \nassessment of vascular (co)morbidity. For these purposes, the use of visual \nrating scales allows a fast and reprodu cible assessment of global/regional \ncortical atrophy and vascular white matter pathology. More recently, new \nimaging markers such as cerebral microble eds and superficial siderosis haven \nbeen identified and linked to Alzheimer pathology. In addition, next to structural \nMRI, advanced and quantitative MRI methods have been introduced in the \nclinical setting. MRI perfusion techniques such as arterial spin labelling (ASL) \ndemonstrated a diagnostic value in memory clinic patients, particularly in those \nshowing no or inconclusive pathology on structural MRI.  \nLearning Objectives:\n1. To become familiar with pathophysiology and clinical manifestations of \ncommon dementing disorders. \n2. To learn how to define a comprehensive imaging protocol for dementia \nwork-up. \n3. To appreciate the role of modern imaging techniques for defining structural \nsigns of dementia. \nAuthor Disclosure:\n M.P. Wattjes: Advisory Board; Biogen Idec. Board Member; European \nRadiology. \nA-544 09:21 \nC. Molecular imaging: when is it needed?  \nH. Urbach, P.T. Meyer; Freiburg/DE (horst.urbach@uniklinik-freiburg.de) \nCognitive decline is a clinical symptom in many neurodegenerative disorders. \nMRI is typically performed in the initial diagnostic workup of these patients. As \na structural imaging modality, MRI is often unrevealing while several molecular \nimaging modalities show disease-associated alterations: \n18F-FDG-PET shows \nreduced glucose metabolism in neocortical  association cortices, mainly in the \nposterior cingulate, precuneus and temporoparietal regions. Since glucose \nmetabolism is normally higher in the posterior cingulate and precuneus, \nreduced glucose metabolism must be specifically sought for or highlighted by \nvoxel-based analysis.  18 F-FDG-PET aids in the diagnosis of frontotemporal \nlobar degeneration (FTLD), cortico-basal degeneration (CBD) and dementia \nwith Lewy bodies (DLB) by showing fronto-temporal, asymmetric fronto-parietal \nor temporo-parieto-occipital hypometa bolism, respectively. Amyloid imaging \nwith \n11C-PiB and 18F-labelled compounds is of great research interest. Although \nthe first compound has recently been approved for clinical use in the USA and \nEU, availability is still limited. Nigrostriatal degeneration highlighted by \n18F-\nfluorodopa-PET or (dopamine transporter) 123I-FP-CIT-SPECT is present in \nParkinson's disease (PD), CBD, DLB, multiple system atrophy (MSA), and \nprogressive supranuclear paralysis (PSP), but absent in essential tremor or \ndrug-induced parkinsonism. Patients with vascular parkinsonism may show \nfocal defects to normal tracer uptake. In MSA and less so also CBD and PSP, \n123I-iodobenzamide-SPECT shows a loss of striatal dopamine receptors, while \ncardiac 123I-metaiodobenzylguanidine uptake (i.e., post-ganglionic sympathetic \ninnervation) is normal in contrast to Parkinson's disease. However, recent \nstudies demonstrate that 18F-FDG-PET is superior for the differential diagnosis \nof parkinsonism showing striatal and cerebellar hypometabolism in MSA and \nmainly frontal (mesial and premotor cortex), thalamic and brainstem \nhypometabolism in PSP.  \nLearning Objectives:\n1. To become familiar with the molecular pathology of common dementing \ndisorders. \n2. To appreciate technical aspects and interpretation of SPECT and PET in \ndementia. \n3. To understand the interpretation and significance of molecular imaging in the \ndiagnosis of dementia. \nPanel discussion:  \nHow to integrate imaging, clinical and CSF findings into a dementia \nclinic?  \n09:44\n08:30 - 10:00 Room I/K  \nHead and Neck Imaging  \nCC 1619  \nTailoring head and neck examinations to \nthe clinical symptoms (part 2)  \nModerator:  \nP.-Y. Marcy; Nice/FR \nA-545 08:30 \nA. Horner's syndrome  \nD.L. Reede; Brooklyn, NY/US (Deborah.Reede@downstate.edu) \nHorner's syndrome (HS) occurs when there is interruption of the \noculosympathetic pathway (OSP). This presentation reviews the anatomy of \nthe OSP and clinical findings associated with lesions along this pathway. The \nimaging findings of lesions associated with HS at various levels of the OSP, \nclassified as preganglionic HS (first- and second-order neuron HS) or \npostganglionic HS (third-order neuron HS) are demonstrated. Imaging and \nclinical findings of common lesions encountered at various levels of the OSP \nare presented to demonstrate the role of imaging in the evaluation of patients \nwho present with HS. The clinical symptoms of HS may cause little if any \nfunctional impairment in most patients. However, since both benign and \nmalignant processes are associated with HS, a thorough clinical evaluation is \nrequired. Once a lesion is localised clinically within the OSP by a combination \nof physical examination and pharmacological testing, the radiologic \nexamination can be appropriately tailored.  \nLearning Objectives:\n1. To understand the importance of this syndrome as well as its common and \nuncommon causes. \n2. To become familiar with crucial anatomical landmarks. \n3. To learn about the imaging findings. \n\nA B C D E F G S121  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-546 09:00 \nB. Dysphagia  \nP. Pokieser; Vienna/AT (peter.pokieser@meduniwien.ac.at) \nDynamic imaging of swallowing from the mouth to the duodenum is the only \nclinical test providing a fast and accurate diagnostic overview of the upper GI \nfunction. Swallowing disorders are divided into those with dysphagia that \nmeans problems during eating or drinking, with suspicion of aspiration as an \nimportant subgroup and those with sensations like the globus syndrome or \nnoncardiac retrosternal pain. Oropharyngeal dysphagia in patients with \nneuromuscular diseases or postoperative conditions can be evaluated \nprecisely and within the same session as oesophageal motility disorders, \nstenoses or postoperative problems are detected and in a complementary \nfashion to endoscopy, pH monitoring and manometry. The exclusive ability of \ndynamic imaging of swallowing is to diagnose combined disorders of the \npharynx and the oesophagus, to detect and localise subtle and multiple benign \nstenoses of the upper GI tract and to combine visualisation of pathophysiology \nand bolus transport as well. Radiologic evaluation concentrates on 7 functional \nunits, which represent the visible \"movi ng areas\" of deglutition, where evident \npathologic conditions can be found: 1) oral cavity and tongue, 2) soft palate, 3) \nepiglottis, 4) hyoid and larynx, 5) pharyngeal constrictors, 6) \npharyngoesophageal segment, 7) oesophagus and stomach. This lecture \nintends to explain the common causes of dysphagia, the approach to a tailored \nexamination and the use of an advanced imaging technique. Further, the \nbasics of taking the swallowing history and the structure of reporting \nswallowing disorders along the seven functional units will be provided.  \nLearning Objectives:\n1. To understand the common causes of dysphagia. \n2. To learn how to tailor radiological examinations to the symptoms. \n3. To become familiar with advanced imaging techniques helpful in the \nevaluation of swallowing difficulties. \nA-547 09:30 \nC. Hoarseness  \nF.A. Pameijer; Utrecht/NL (f.a.pameijer@umcutrecht.nl) \nHoarseness is defined as a rough or noisy quality of voice. The possible \ncauses of hoarseness are manifold, ranging from benign diseases such as the \ncommon cold to malignant tumours. Therefore, hoarseness as a symptom \nshould always be taken seriously. Evaluation of a patient with hoarseness by a \nhead and neck specialist will always starts with a history and a physical \nexamination including laryngoscopy. After these examinations, a diagnosis can \nbe established in most patients without addi tional imaging. The aetiologies of \nhoarseness are: 1) inflammation/infection, 2) trauma, 3) neoplasms, 4) others \n(including medical conditions, e.g. hypothyr oidism) and 5) vocal cord paralysis. \nThis presentation will focus on imaging of vocal cord paralysis. Vocal cord \nparalysis should not be considered a diagnosis, but as a symptom of (possible) \nunderlying disease. When vocal cord palsy is discovered, this is frequently a \nreason to perform cross-sectional imaging. The radiological workup needs to \ninclude the full course of the vagus nerve. Moreover, reporting radiologists \nneed to be able to recognise the radiological signs of vocal cord palsy in the \nabsence of hoarseness, since many patients with cord palsy are asymptomatic \n(up to 30%). The anatomy of the vagus nerve and its laryngeal branches that \ninnervate the intrinsic muscles of the larynx will be discussed. Then the \n(expected) course of the vagus nerve and recurrent laryngeal nerve will be \nshown. Finally, radiological signs of vocal cord palsy will be discussed using \nexamples from daily practice.  \nLearning Objectives:\n1. To understand the underlying causes of this clinical symptom and their \nimportance. \n2. To learn what to look for and which imaging method to use. \n3. To become familiar with differential diagnosis and the limitations of \ndiagnostic imaging studies. \n08:30 - 10:00 Room L/M  \nSpecial Focus Session  \nSF 16d  \nImaging follow-up of vascular \ninterventions  \nA-548 08:30 \nChairman's introduction  \nM. Szczerbo-Trojanowska; Lublin/PL (mst@radiology.com.pl) \nIn contemporary medicine, endovascular techniques often replace \nconventional methods of treatment, including surgery, in the management of \nan increasing range of diseases. This requires development of specific \nmethods assessing the effectiveness of treatment and able to detect \ncomplications that may be much different from those occurring in conventional \ntherapy. This is first of all seen in the endovascular treatment of patients \nsuffering from vascular lesions and neopl astic diseases. Commonly, there is a \nhigh initial technical success of endovascular treatment, but the durability is not \nalways satisfactory and needs to be further examined. Endovascular treatment \nis bound to the risk of specific complicati ons, often without clinical symptoms. \nTherefore, there is a need to use imaging follow-up of these patients. \nInterventional radiologists are aware of the importance of those issues and \nshould play an important role in devel oping and deciding about the follow-up \nscheme and choice of the best imaging methods for these patients. Besides in-\ndepth knowledge of the treatment, radiologists are also familiar with the \npossible complications and can offer an optimal, minimally invasive and cost \neffective diagnosis and treatment.  \nSession Objectives: \n1. To learn about the long-term results of vascular interventions. \n2. To become aware of the complications in vascular interventions in general. \n3. To become familiar with the endovascular treatment of complications \nfollowing vascular interventions. \nA-549 08:35 \nImaging follow-up and treatment of complications of angioplasty and \nstenting  \nR. Morgan; London/UK (robert.morgan@stgeorges.nhs.uk) \nThe potential imaging methods for follow-up after angioplasty (PTA) and/or \nstenting include Doppler ultrasound, CTA and MRA. Although excellent images \ncan be obtained by CTA and MRA, the drawbacks of these studies for routine \nfollow-up are obvious. (access to CT and MR equipment, cost, contrast \nmedium, ionising radiation, etc). In the UK, the most common imaging method \nis duplex ultrasound. There is no established role for the use of ultrasound \ncontrast agents. Ultrasound is freely available in the majority of centres, is \ninexpensive and complication free. Follow-up by ultrasound may be \nundertaken by radiologists, although more usu ally by technologists in vascular \nlaboratories. In practice, few patients are followed up by any imaging study at \nall unless they develop symptoms. The main category of patients who undergo \nsome form of imaging follow-up after PTA/stenting are patients with surgical \nbypass grafts, who are usually routinely followed up whether they have \nundergone angioplasty/stenting or not. In view of the fact that this is a lecture \non follow-up after intervention, procedural complications are excluded from the \ndiscussion. The complications of angioplas ty and stenting are similar. The \nmain early complications are restenosis or reocclusion. Other early \ncomplications are related to the arterial puncture site and include haematoma, \ndissection, occlusion and pseudoaneurysms. The main late complications are \nrestenosis and reocclusion. Treatment of restenosis and reocclusion usually \ninvolves additional angioplasty or sten ts using conventional or drug-eluting \nballoons or stents. Cutting balloons, atherectomy and cryotherapy have a \ncontroversial role based on limited evidence.  \nLearning Objectives:\n1. To learn about selection of imaging methods used for follow-up. \n2. To become aware of the early and delayed complications. \n3. To become familiar with endovascular methods used to treat complications. \nA-550 08:58 \nImaging methods for postprocedural evaluation and follow-up of EVAR  \nE. Brountzos; Athens/GR (ebrountz@med.uoa.gr) \nImaging after EVAR primarily focuses on the prevention of aneurysm rupture. \nOther late complications include limb occlusion, graft migration, graft infection, \nand endoleaks. CT angiography (CTA) at standardised intervals has been the \nmodality of choice. Recently, concerns regarding radiation exposure, contrast-\ninduced nephropathy and increasing costs advocate for less CTA imaging \nand/or for changing the surveillance protocols. Ultrasonography accurately \nmeasures aneurysm size, while CEUS detects endoleaks with high sensitivity. \nNo endoleaks requiring interventions will be missed by ultrasound. Ultrasound \nonly can be used in patients with appropriate body habitus, without EVAR-\nrelated problems (as demonstrated on earlier CTAs), or in patients with \nshrinking or stable aneurysms. Use of duplex only will not lead to an increased \noccurrence of adverse events such as rupture, graft migration or limb \nocclusion, and can lead to a significant reduction of costs related to EVAR \nfollow- up by 29%. The presence of endoleak at 30 days is associated with an \nincrease in secondary procedures; absence of early endoleak is associated \nwith a reduced risk for subsequent aneurysm-related morbidity. Patients with \naneurysm sacs that are stable or shrinking at 1 year and no evidence of \nendoleak on a CT scan performed at 1 year do not require regular CT scanning \nanymore and can be imaged with ultrasonography.  \nLearning Objectives:\n1. To learn about imaging protocols used for follow-up. \n2. To become aware of complications of EVAR. \n3. To become familiar with methods used to treat complications. \n\nA B C D E F G S122  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-551 09:21 \nImaging follow-up of oncologic patients after embolisation procedures  \nJ.I. Bilbao; Pamplona/ES (jibilbao@unav.es) \nThe term \"embolisation\" groups different procedures in which imaging \nguidance is fundamental for both performing the procedure and for the early \ndetection of complications. It has been demonstrated by several studies that \n\"tumoural response\" is tightly associated with survival, thus it is of major \ninterest to measure accurately how the tumour is modified by the treatment. \nThe \"World Health Organisation\" - WHO - first published the objective criteria \nfor the evaluation of response. These cri teria were slightly modified in 2000 \nand named as \"Response Evaluation Criteria for Solid Tumors\"- RECIST. \nAccordingly, \"complete response\" (CR) corresponds to the disappearance of \nthe tumour, \"partial response\" (PR) is defined when there is a decrease in the \ntumour size equal to or higher than 30% and \"progressive disease\" (PD) is \napplied when there is an increase equal to or higher than 20%. \"Stabilisation of \nthe disease\" (SD) corresponds to measurements in between > 30% (PR) and \n< 20% (PD). Tumours (until five nodules in the same viscera), no matter if \nnecrotic or viable, were evaluated with one measure (its largest diameter). A \nnew version (\"1.1 RECIST) has introduced modifications, among which is the \nnumber of nodules (2 instead of 5) that needs to be evaluated. In some \ncircumstances, when morphologic criteria (RECIST and WHO) fail to predict \nthe outcome, then new functional criteria have been recently established. \n\"mRECIST\" (which only measures the tumour that uptakes contrast) is an \naccurate classification for HCC. New methods \"beyond RECIST\" have been \nestablished for some specific treatments such as targeted therapies.  \nLearning Objectives:\n1. To learn how to assess results. \n2. To understand how to diagnose and treat early complications. \n3. To learn how to manage recurrent oncological bleeding. \nAuthor Disclosure:\n J.I. Bilbao: Speaker; Sirtex Medical Europe. \nPanel discussion:  \nCost-effectiveness of imaging follow-up after endovascular  \ninterventions  \n09:44\n08:30 - 10:00 Room N/O  \nSpecial Focus Session  \nSF 16e  \nElastography as a new tool  \nA-552 08:30 \nChairman's introduction  \nA. Wieczorek; Lublin/PL (rtg@dsk.lublin.pl) \nIn this session, the audience will have a comprehensive overview of the \nelastography, its principles and current state-of-the-art clinical applications. \nThe session will deliver an overview of currently available methods of both \nultrasound elastography (USE) and magnetic resonance elastography (MRE), \ntheir physical principles, technical and equipment requirements as well as the \ninfluence of various factors for obtained results. Following this session, the \naudience will have insight into clinical applications of elastography in liver, \nprostate and brain diagnostics. The strengths and weaknesses of \nelastographic modalities will be compared and discussed under consideration \nof more established imaging modalities. The session will present potential \ndevelopments of USE and MRE and possibl e future clinical applications. Panel \ndiscussion will aim at defining the place of elastography in current and future \ndiagnostic algorithms.  \nSession Objectives: \n1. To learn about the basic idea of elastography. \n2. To understand the methods of acquiring elastographic images. \n3. To learn about the common indications. \nAuthor Disclosure:\n A. Wieczorek: Speaker; Speaker supported by B-K Medical Workshops and \nLectures. \nA-553 08:35 \nPrinciples of US and MR elastography  \nI. Sack; Berlin/DE (ingolf.sack@charite.de) \nThe well-known sensitivity of the palpating hand for detecting lesions is related \nto the incredibly wide range of values of the shear modulus in the body, \nspanning over eight orders of magnitude. Elastography was invented to exploit \nthis high variability of constants by introducing the shear modulus into the \nimage contrast of medical ultrasound or magnetic resonance imaging. Today, \nboth ultrasound elastography (USE) and magnetic resonance elastography \n(MRE) are in clinical use, predominantly for staging liver fibrosis or \ndiscriminating tumours in the breast, liver, and prostate. The talk reviews the \nphysical principles, technical requirements and current methods of both USE \nand MRE. Furthermore, the strengths and weaknesses of elastographic \nmodalities are compared and discussed under consideration of more \nestablished imaging modalities. An outlook of elastography is given, \nhighlighting the real-time feasibility of USE and the sensitivity of MRE to tissue \npressure.  \nLearning Objectives:\n1. To learn what elastography is good for and why we need it. \n2. To understand the advantages and disadvantages of ultrasound-based \nelastography (USE) compared with MR elastography (MRE). \n3. To become familiar with the different methods in both USE and MRE. \n4. To learn about the clinical applications. \nA-554 08:53 \nUS elastography of the prostate  \nF. Aigner; Innsbruck/AT (friedrich.aigner@uki.at) \nSuspicion of prostate cancer (PCa) exists in the case of elevated PSA serum \nvalues and/or suspicious findings on digital rectal examination (DRE). \nSystematic biopsy (SB) will be done to confirm or rule out PCa. Unfortunately, \nan elevation of PSA serum values often is caused by benign changes, e.g. \nprostatitis or adenomyomatosis and not every cancer is palpable on DRE. \nFurthermore, SB may miss clinically significant disease in up to 35%. \nTherefore, a more targeted approach would be desirable and imaging of PCa \nis currently under strong effort. One possibility for visualisation of PCa is the \nrepresentation of tissue elasticity. Usually, cancers have higher cell and vessel \ndensity than the normal surrounding tissue and therefore are associated with \nincreased stiffness. In contrast to DRE, where only the posterior parts of the \nprostate can be reached, RTE does not have this problem, since all anatomical \nregions can be evaluated. Furthermore, this noninvasive technique is time-and \ncost-effective and targeted biopsy or focal therapy of the prostate can be done \nunder real-time conditions. Another important issue is that RTE can be \nperformed by both urologists and radiologists. Nevertheless, RTE is of limited \nvalue in the detection of small cancer lesions and there may be problems in \nvisualising PCa with predominantly Gleason pattern 3. The lack of data about \ninter- and intraobserver variability and of multicentre studies (now in process) \nare probably the reasons why RTE has not been included in the guidelines of \nurological societies so far.  \nLearning Objectives:\n1. To understand histopathological patterns of prostate cancer (PCa) in \ncorrelation with imaging. \n2. To appreciate the advantages of elastography compared with systematic \nbiopsy. \n3. To become familiar with the limitations and potentials of elastography for \nPCa detection. \nA-555 09:11 \nMR elastography of the brain  \nJ.-T. Wuerfel; Göttingen/DE (jens.wuerfel@charite.de) \nCerebral tissue structure is altered in many neurodegenerative diseases, but \nalso during physiological processes like maturation or ageing. Structural \nchanges directly affect the mechanical tissue properties. Magnetic resonance \nelastography (MRE) is an imaging technique capable of assessing \nbiomechanical brain parenchymal properties  non-invasively. Viscoelasticity can \nbe quantified by analysing the propagation of mechanically elicited shear \nwaves in the investigated tissue. Thus, MRE could be a helpful tool to detect \nphysiological or pathological processes infl uencing the cerebral tissue integrity.  \nLearning Objectives:\n1. To appreciate the advantages and limitations of a virtual palpation of the \nbrain. \n2. To become familiar with mechanical wave induction and detection in \ncerebral measurements. \n3. To learn about current and potential clinical applications. \n4. To learn about the relationship between microscopic and macroscopic, as \nwell as focal and globally diffuse biomec hanical brain parenchymal alterations. \nAuthor Disclosure:\n J. Wuerfel: Advisory Board; Novartis Advisory Board. \nA-556 09:29 \nUS and MR elastography of the liver: assessment of liver stiffness with \nelastography techniques  \nS.F. Bensamoun; Compiegne/FR (sabine.bensamoun@utc.fr) \nUltrasound (US) and magnetic resonance elastography (MRE) techniques are \nused in clinical practice for liver exam. These new techniques enable a \nnoninvasive follow-up of treatment and therapy. The objective of this talk is to \nshow the different steps of US and MR elastography methods performed by \nthe radiologist to diagnose the level of fibrosis. Briefly, elastography techniques \n\nA B C D E F G S123  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nare based on the generation of shear waves inside the liver tissue with specific \nMR liver drivers and ultrasound probes. Subsequently, phase images revealing \nthe displacement of the waves will be investigated for healthy and pathological \n(alcoholic fibrosis) livers. Moreover, th e development of phantoms mimicking \nthe stiffness of biological soft tissues (liver, muscle, … ) will be also presented. \nThe viscoelastic (elasticity and viscosity) pro perties of healthy and fibrotic livers \nwere measured, and the relevance of these parameters, used as a liver \ndiagnostic marker, was analysed. In parallel, an increase of the wavelength as \na function of the stiffness was obtained for the developed set of phantoms. The \ncharacterisation of the elastic properties is an excellent marker to differentiate \nminor and major fibrosis. A summary of the advantages and disadvantages of \nUS and MR elastography techniques will be presented.  \nLearning Objectives:\n1. To learn how MR elastography and elastography techniques function. \n2. To understand how to evaluate the liver with elastography. \n3. To appreciate the diagnostic value of elasticity and viscosity. \n4. To become familiar with US and MR elastographic imaging techniques for \nnon-invasive follow-up of treatment and therapy. \nPanel discussion:  \nElastography - a revolutionary technique or a waste of time?  \n09:47\n08:30 - 10:00 Conf. Room M3  \nOncologic Imaging: Follow-up of Systemic and Local Therapies  \nCC 1618  \nFollow-up of local treatments of breast \ncancer  \nModerator:  \nM.H. Fuchsjäger; Graz/AT \nA-557 08:30 \nA. MRI-guided HIFU therapies in the breast  \nM. Sklair-Levy; Tel Aviv/IL (mirisklair@gmail.com) \nMagnetic resonance high-intensity focused ultrasound is an innovative, \nnoninvasive tumour ablation technique. MRI and focused ultrasound are \ncombined allowing real-time anatomic guidance and temperature mapping \nduring treatment. MRI-g FUS treatment is performed under local anaesthesia. \nImaging: T2-W to define the tumour and T1-W with contrast to verify the \nefficacy after MRgFUS. MRI-guided FUS ablation of breast cancer studies \ndemonstrates variable results with complete tumour necrosis in 20% to 100%. \nMRI-guided FUS procedure is well tolerated, with only a minor complication \nsuch as skin burn. Several issues need to be further investigated for successful \ncancer treatment with MR-guided focused US, including patient selection, \ndefinition of treatment margins and optimal transducer technology. In \nsummary, FUS ablation has the potential to become an important modality for \nnoninvasive image-guided treatment of localised breast cancer.  \nLearning Objectives:\n1. To learn about HIFU in breast tumours. \n2. To become familiar with the post-HIFU aspects of various types of imaging. \nA-558 09:00 \nB. Pre-imaging and post-imaging appearance of breast lesion excision \nsystem (BLES) lesions  \nS.D. Allen; Sutton/UK (steven.allen@rmh.nhs.uk) \nThe breast lesion excision system (BL ES) has evolved as a breast radiological \ntechnology over the last decade and is now in widespread use in Europe and \nacross the world. It was designed as a large biopsy device, but more recently \ndue to its unique capability to obtain a single large breast tissue specimen in \nonly a few seconds by utilising a radiofrequency cutting and cauterising wave, \nit has increasingly been explored in the therapeutic setting. It is easy to use \nunder ultrasound or mammographic guidance with procedures taking a similar \nlength of time to that of a vacuum biopsy, and with patient preparation and \nanaesthetic essentially identical. Th e technical aspects of performing these \nprocedures will be detailed as well as its use specifically to perform excisional \nbiopsies. This is limited by patient and lesional factors, all of which will be \ndiscussed in more detail. Following a BLES, the post-procedure appearances \nneed to be considered so that follow-up imaging can be interpreted accurately. \nThe risks and complications of this procedure are outlined as well as a \ndiscussion made of the latest papers in this field that may suggest future \napplications and developments.  \nLearning Objectives:\n1. To understand the mechanism of the BLES technique. \n2. To become familiar with the post-BLES aspects of various types of imaging. \nA-559 09:30 \nC. Common features and pitfalls in imaging the treated breast  \nJ. Camps Herrero; Valencia/ES (juliacamps@gmail.com) \nDuring the past few years, it has been shown that there is not a single disease \nentity called \"breast cancer\". There are different subtypes that entail diverse \nrecurrence risks. This is the first issue to take into account, and patients will be \nstratified accordingly before any follow-up is planned. Imaging findings in a \npatient treated for breast cancer will depend on the type of treatment: breast \nconserving therapy (BCT), mastectomy (and all the reconstructive techniques), \nradiotherapy and minimally invasive techniques. To differentiate between fat \nnecrosis and other common post-treatment changes from relapse, it is \nimportant to know the timeline when all these changes take place and also \nschedule the follow-up imaging procedures accordingly. Other important issues \nto take into account are the limitations and indications of the different \nmodalities (mammography, ultrasound and MRI). Although ultrasound and \nmammography have traditionally been used in the follow-up of these patients, \nMRI is being used more and more often due to its superior multiplanar \ncapabilities and the functional information not supplied by the other techniques.  \nLearning Objectives:\n1. To learn about the postsurgical and post-radiation therapies aspects of the \nbreast and their timing. \n2. To learn how to diagnose a recurrence in the treated breast and its \ndifferential diagnoses. \n3. To become familiar with the imaging findings of post-ablation (RFA) of \nbreast. \nAuthor Disclosure:\n J. Camps Herrero: Advisory Board; Bayer. Speaker; Bayer. \n08:30 - 10:00 Board Room A  \nVascular  \nRC 1615  \nVenous thrombosis: imaging and \nmanagement  \nA-560 08:30 \nChairman's introduction  \nO. Pellerin; Paris/FR (olivier@pellerin.as) \nVenous thrombosis is a serious health issue. Two clinical presentations exist \nand both are under the scope of the radiologist. Despite a high efficacy rate of \nanticoagulation, treatment failure or complication occurs. The prevention of \npulmonary embolism and the management of proximal vein occlusion could be \ndone by the interventional radiologist (vena cava filtration, ilio-femoral venous \nnetwork recanalisation). The chronic phase of venous thrombosis is \nresponsible for post-thrombotic syndrome. This complication needs to be \nknown by the radiology community, be cause of its insidious presentation and \nthe dramatic results of recanalisation w hen indicated. The goal of this session \nis to point out the clinical importance of venous thrombosis imaging, by \nshowing how to diagnose acute or chronic presentation, and to show the \nrationale of the technique and results of interventional radiologic procedure for \nvena cava filtration, and acute and chronic vein occlusion.  \nAuthor Disclosure:\n O. Pellerin: Advisory Board; Siemens Interventional Oncology Advisory \nBoard. Employee; Assistance Publique - Hôpitaux de Paris. \nA-561 08:35 \nA. Ultrasound, CT and MR venography  \nM. Das; Maastricht/NL (m.das@mumc.nl) \nBlood clot formation in the veins is referred to as venous thrombosis (VT). VT \nis most common in the deep veins of the legs and pelvis. If the thrombus \ndislocates to the pulmonary arteries this is referred to as pulmonary embolism \n(PE). The combination of deep vein thrombosis (DVT) and PE is referred to as \nvenous thromboembolism (VTE). The diag nosis of DVT and VTE is essential, \nas VTE is potentially fatal. Furthermore, undiagnosed, non-fatal DVT may \nresult in negative long-term pathologies (e.g. post-thrombotic syndrome). Major \nrisk factors for the development of VTE are thrombophilia, history of DVT, age \n> 60, surgery, obesity, long travel, cancer, immobility and pregnancy. In \naddition, underlying congenital abnormalities or compression syndromes (May-\nThurner syndrome) are also important to diagnose. Diagnosis of VTE is not \nalways easy. Primary diagnosis includes clinical (Wells Score) and lab testing \n(D-Dimer). First line imaging testing is done by leg ultrasound (US). If PE is \nsuspected CT is indicated immediately. CT of the pulmonary arteries (CTPA) \nmay be combined with indirect CT venography (CTV). The question of when to \ncombine CTPA and CTV still remains. A favourable approach is to add CTV in \n\nA B C D E F G S124  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\na negative CTPA. Recently MR venography (MRV) is emerging as \ncomprehensive imaging tool especially in patients with chronic DVT to assess \nthe extent and underlying causes. In this respect imaging without radiation \ndose with high spatial delineation of vascular abnormalities facilitates \nintervention for thrombolysis or interventional therapy including recanalisation \nand stenting.  \nLearning Objectives:\n1. To learn about the pros and cons of US compared to CTV and MRV. \n2. To become familiar with imaging parameters, contrast media protocols, flow \ndependent techniques and flow independent techniques. \n3. To understand pitfalls and artefacts characteristic of the respective imaging \nmodalities. \nAuthor Disclosure:\n M. Das: Consultant; Bayer Healthcare, Siemens Healthcare. Research/Grant \nSupport; Institutional Grant from Bayer, Siemens. \nA-562 08:58 \nB. Epidemiology, prevention and treatment  \nC. Binkert; Winterthur/CH (christoph.binkert@ksw.ch) \n1. Epidemiology: acute deep vein thrombosis (DVT) is a common disease \naffecting 70-100 patients per 100'000 per year. A feared complication of DVT is \npulmonary embolism (PE). 2. Prevention. a) Medication: low molecular heparin \n(LMH) is widely used for immobilised patients to minimise the risk of DVT. \nAlternatively, intravenous unfractionated heparin is used in situations when a \nquick reversal is necessary. b) Non-medication: early mobilisation has been \nwidely adopted to activate the muscle pump. If early mobilisation is not \npossible, compression stockings and/or pneumatic compression boots are \napplied to better empty the veins. 3. Treatment: a) Anticoagulation: the main \ngoal of anticoagulation is to prevent progression and recurrence of DVT. \nTypically, anticoagulation is started with LMH, followed by vitamin K \nantagonists (Coumadin). The first DVT is generally treated for 3-6 months; \nrecurrent DVT for 12 months. b) Compression therapy: compression stockings \nameliorate pain and leg swelling of acute DVT. In addition, the development of \na post-thrombotic syndrome (PTS) should be reduced. c) Thrombolysis: the \nmain goal of thrombus removal is prevention of PTS. In addition, thrombolysis \nis used for severe ilio-femoral DVT, especially with phlegmasia coerulea \ndolens. There are different ways of thrombolysis: systemic thrombolysis was \nabandoned because of high bleeding complications. Catheter-based \nthrombolysis has shown to reduce the bleeding risk, but it is quite time and \nresource consuming. The latest development is pharmaco-mechanical catheter \nthrombus removal which combines thrombolytic drugs with a mechanical \nmaceration. Recent studies (CaVent,TORPEDO) have shown a reduction of \nPTS compared to anticoagulation.  \nLearning Objectives:\n1. To learn about the epidemiology and clinical presentation of venous disease. \n2. To become familiar with effective prevention measures. \n3. To learn about the different endovascular treatment options. \nAuthor Disclosure:\n C. Binkert: Speaker; Cook, Covidien. \nA-563 09:21 \nC. IVC filters  \nG.J. O'Sullivan; Galway/IE (gerard.osullivan2@hse.ie) \nThe use of inferior vena cava filters (IVCFs) is a controversial method for the \nprevention of pulmonary emboli. There are large variations in their usage; often \nwith ten to one hundredfold differences in placement between different \ncountries. Ideally, IVCF usage is based on sensible protocols derived from \nclinical experience and trials. In practice, this is less frequently the case. \nIndications, contraindications and q uestionable indications (mainly during \nvenous thrombolysis) will be discussed. Familiarity with ultrasound guidance \nwill be stressed. The key technical steps in the insertion and removal of IVCFs \nwill be discussed.  \nLearning Objectives:\n1. To learn the rationale for IVC filter placement. \n2. To become familiar with the key technical steps and learn how to avoid \ncomplications during IVC filter placement. \n3. To become familiar with the key technical steps and learn how to avoid \ncomplications during IVC filter retrieval. \nAuthor Disclosure:\n G.J. O'Sullivan: Consultant; Covidien Healthcare, Cook Medical, Marvao \nMedical, Optimed, Veniti Medical, Bard, Medtronic, Boston Scientific. \nPanel discussion:  \nCurrent indications for interventional venous thrombosis  \ntreatment  \n09:44\n08:30 - 10:00 Room P  \nComputer Applications  \nRC 1605  \nImproving workflow efficiency and quality  \nA-564 08:30 \nChairman's introduction  \nD. Caramella; Pisa/IT (davide.caramella@med.unipi.it) \nThe question that this refresher course is aimed to answer is whether novel IT \ntools may actually help in improving quality and workflow efficiency in daily \nradiological practice. In fact, since the early installations of PACS, IT tools have \noften been considered as mere productivity tools rather than enabling \ntechnologies for fostering quality in m edical care. The three distinguished \nlecturers in this course will address the following topics: improving quality and \nefficiency of computerised order entry through decision support, improving \nquality and efficiency of reporting through structure and templates, and \nimproving quality and efficiency of dose management through exchange \nbetween modalities and registries. They will cover all aspects of the \nradiological workflow: from the selection of the most appropriate diagnostic \nprocedure, to the efficient reporting of diagnostic and non-diagnostic data \n(such as radiation dose information and contrast media information). They will \ndemonstrate how newly adapted IT tools may provide assistance throughout \nthe radiological workflow, with potentially  enormous gains in terms of patients' \nsafety and total quality management.  \nSession Objectives: \n1. To appreciate the need for IT tools to ensure quality control. \n2. To understand how to collect data concerning radiation dose. \n3. To learn about the integration of contrast media injectors into PACS. \nA-565 08:35 \nA. Improving the quality and efficiency of computerised order entry \nthrough decision support  \nP. Mildenberger; Mainz/DE (peter.mildenberger@unimedizin-mainz.de) \nElectronic communication of requests for radi ological procedures is a logical \nand relevant extension to integrated information systems in health care. This \ncommunication of orders and the entry (OE) into RIS improve the workflows. \nBut, quality improvements require additional efforts to link order-entry-solutions \nwith health knowledge for ordering the appropriate imaging procedure. These \nClinical Decision Support (CDS) tools should be based on generally accepted \nand implemented criteria, e.g. evidence-based medicine. It is known that the \nacceptance of such systems, if successful and efficient implementations are \ngiven, is very good. IT concepts for CDS are well known and standards for \nclassifications are available, but semantic interoperability is still a developing \narea. Actually, clinical information systems provide different levels of \nintegration of OE and CDS. Further developments could be an implementation \nof interoperability profiles and the representation of CDS knowledge in web-\nbased services of non-commercial organisations.  \nLearning Objectives:\n1. To understand the relationship between decision support tools and \nevidence-based medicine. \n2. To learn how decision support tools can be implemented for requesting \nradiological studies. \n3. To appreciate the potential effects of decision support tools on workflow \nefficiency. \nA-566 08:58 \nB. Improving quality and efficiency of reporting through structure and \ntemplates  \nE. Neri; Pisa/IT (emanueleneri1@gmail.com) \nThe report represents the final stage of the diagnostic imaging process, for \nwhich the radiologist is responsible. This process is driven by an accurate \nselection of the diagnostic tests, based on the clinical question. Therefore, the \nreport should be an expression of this path, depending on the question asked \nby the clinician. The structure of a radiology report for the same clinical \nproblem and the same method of investigation varies from country to country \nand between different radiologists. This di versity can be a problem in the global \nworld where a patient can have imaging tests from different places with \ndifferent reporting languages, or when patient data is transmitted and shared \nbetween different centres. There is, therefore, the need to standardise the \nreport as much as possible; finalising its structure and contents to a specific \nclinical problem, and possibly using a standard terminology. An attempt to \nsolve this problem is in progress with the joint initiative on structured report \nESR- RSNA (http://www.rsna.org/Reporting_Initiative.aspx), aimed at \nimproving reporting practises by creating a library of clear and consistent report \n\nA B C D E F G S125  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\ntemplates. The main expected benefits of structured reporting templates are \nreport uniformity and improvement of communication between referring \nphysicians. Literature evidences that structured reporting can also quicken \nreport turnaround, and reduce costs and lexical errors; thereby improving the \nquality and safety of radiological practise.  \nLearning Objectives:\n1. To learn about clinical requirements for structured reports. \n2. To become familiar with the IT requirements for report templates. \n3. To appreciate the potential for generating data for evidence-based radiology. \nA-567 09:21 \nC. Improving quality and efficiency of dose management trough \nexchange between modalities and registries  \nE. Vaño; Madrid/ES (eliseov@med.ucm.es) \nThe European directive on Medical Exposures requires the assessment and \nevaluation of patient doses, especially in procedures involving high doses to \nthe patient. In the current draft of the new directive on Basic Safety Standards, \nsome requirements on patient dosimetry in diagnostic and interventional \nradiology have been reinforced: X-ray systems should provide dosimetric \ninformation with the capability of being transferred to the examination report \n(for all CT and interventional systems). Diagnostic reference levels (DRLs) \nshall be reviewed regularly. These requirements will push the industry and the \nusers to develop better strategies to evaluate patient doses, transfer these \nvalues to patient reports (contributing to the patient exposure tracking system) \nand also use available software to process these dosimetric data and perform \nsome automatic analysis. This analysis should: a) include periodic calibration \nfactors for patient dose quantities, b) in clude automatic detection of high dose \nvalues (especially relevant for interventional procedures), c) include statistical \nanalysis to update DRLs and compare with the existing ones and d) suggest \ncorrective actions to fulfil the quality assurance programmes and the clinical \naudit requirements. DICOM radiation dose structured reports represent a \nsignificant advantage, but more efforts will be necessary for the automatic \nprocess of the relevant data contained in the report to verify that the \nradiological risk is acceptable and to suggest, if appropriate, corrective actions \nto improve clinical practice. Without these last steps, patient dosimetry efforts \nand European regulations for radiation safety could only have a moderate \nimpact.  \nLearning Objectives:\n1. To learn about current European regulatory requirements and standards in \npatient dosimetry. \n2. To become familiar with the dose-reporting evolution and structured dose \nreporting. \n3. To appreciate the potential for dose analysis and reporting, as well as future \nregistries. \nPanel discussion:  \nWill novel IT tools really improve quality and efficiency in daily \nradiological practice?  \n09:44\n10:30 - 12:00 Room A  \nInteractive Teaching Session  \nE³ 1720  \nChanges of the gastrointestinal tract after \ntreatment  \nA-568 10:30 \nA. Gastrointestinal tumours  \nA. Laghi; Latina/IT (andrea.laghi@uniroma1.it) \nGastrointestinal tumors include a variety of lesions, with the most frequent \nbeing adenocarcinoma of the small and large intestine, small bowel lymphoma, \nneuroendocrine tumours (NETs) and gastrointestinal stromal tumours (GISTs). \nAccording to histology, location and initial imaging staging, those lesions may \nrequire completely different therapies: surgery alone, adjuvant chemotherapy \n(CHT), neoadjuvant CHT followed by surgery or a combination of neoadjuvant \nchemoradiotherapy (CRT) followed by surgery. After treatment, imaging \nfollow-up is mandatory. The most common post-operative findings after small \nbowel or colonic resections will be presented, together with clues for early \ndetection of recurrence. In those cases which underwent adjuvant CHT, \nimaging findings and diagnostic criteria related to the use of either cytotoxic or \ncytostatic drugs will be shown, to facilitate the interpretation of radiologists in \nassessing response to therapy. Finally, tissue changes following neoadjuvant \nCRT will be discussed, particularly in rectal cancer. The possibilities of different \nimaging modalities in assessing either complete or partial response to therapy \nwill be presented, with a critical analysis of different imaging findings.  \nLearning Objectives:\n1. To become familiar with common findings after medical treatment of \ngastrointestinal tumours. \n2. To become familiar with changes after radiotherapy for gastrointestinal \ntumours. \n3. To understand the changes which occur after surgery for gastrointestinal \ntumours. \nAuthor Disclosure:\n A. Laghi: Speaker; Bracco, General Electric Healthcare, Im3d. \nA-569 11:15 \nB. Non-tumoural intestinal diseases  \nJ. Rimola; Barcelona/ES (jrimola@clinic.ub.es) \nUnlike infectious enteritis, in patients with Crohn's disease (CD) the changes in \nclinical activity have poor correlation with changes in inflammatory lesions after \nmedical treatment. Mucosal healing (MH) and improvement in patient's \nsymptomatology are usually considered the main objectives of medical \ntreatment. However, improvement in clinical symptoms is not always \nassociated with mucosal healing and the persistence of severe inflammatory \nlesions augurs a more aggressive disease course in terms of flare-ups, \nhospitalisation requirements and the need for surgery. Endoscopy is the gold \nstandard for the assessment of luminal lesions in CD, but given the good \ncorrelation shown between endoscopy and cross-sectional imaging in \nassessing the activity and severity, imaging is increasingly introduced as a tool \nto monitor medical treatment. There is  some evidence indicating that cross-\nsectional imaging can be considered a responsive and reliable tool as it \ndetects meaningful changes in patients' status over time after therapeutic \ninterventions. Besides this, cross-sectional imaging is capable of monitoring \nthe colon and the small bowel and penetrating lesions that cannot always be \nassessed by endoscopy. Becoming familiar with the radiological changes \nduring and after treatment will be key in the decision-making process.  \nLearning Objectives:\n1. To become familiar with useful signs after medical treatment of Crohn's \ndisease. \n2. To understand the changes which occur after recurrence in Crohn's disease. \n3. To understand the alterations which occur after treatment of intestinal \ninfectious processes. \n12:30 - 13:30 Room E2  \nThe Beauty of Basic Knowledge: Skeletal Radiology  \nMC 26E  \nDegenerative disease  \nModerator:  \nV.N. Cassar-Pullicino; Oswestry/UK \nA-570 12:30 \nDegenerative disease  \nK. Bohndorf; Vienna/AT \nDegeneration is routinely defined as a morbid change of cells, tissues and \neven organs. In the MSK system degeneration occurs in bones, joints \n(synarthrosis and diarthrosis), muscles and tendons. Primary degeneration \nimplies ageing as well as overuse, based on mircrotrauma. The latter may be \nrelated to constitutional, professional or sports-related factors. A distinction \nbetween ageing and overuse is not possible with the use of histology and \nimaging. Only the intensity of the changes, which may be inadequate in \nrelation to the age of the patient, may give a hint. On the contrary, the term \n\"secondary degeneration\" should be used for clearly defined events or \ndiseases, which finally will result in the degeneration of tissues. The causes \nare inflammation (RA, infection), metabolic disease (e.g. CPPD) or trauma. \nOther ways to classify degeneration of the MSK system are related to the \nanatomy. Accordingly, degeneration of the particular parts of the peripheral or \naxial skeleton, muscles and tendons has to be discussed. One has to have in \nmind that bones, cartilage, muscles and tendons form a complex unit. The \nsingle elements of these complex units jointly undergo degenerative \ndeterioration, e.g. bone, cartilage, fibrocartilage and capsule are jointly \ninvolved in case of OA of the knee joint. The same holds true for the \nsynchondroses of the spine. At the rotator cuff not only the tendons, but also \nthe underlying bone and the muscle tissue are changed.  \n\nA B C D E F G S126  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nLearning Objectives:\n1. To learn about the underlying pathomechanisms involved in degenerative \nprocesses. \n2. To understand the imaging features of degenerative disease in the \nperipheral skeleton. \n3. To understand the imaging features of degenerative disease in the axial \nskeleton. \n12:30 - 13:30 Room F1  \nThe Beauty of Basic Knowledge: Interventional Radiology  \nMC 25E  \nEssentials of transcatheter embolisation  \nModerator:  \nO.M. van Delden; Amsterdam/NL \nA-571 12:30 \nEssentials of transcatheter embolisation  \nO.M. van Delden; Amsterdam/NL (o.m.vandelden@amc.uva.nl) \nThere are many different types of embolisation, but all share many basic \nprinciples. The specific approach, tec hnique, materials and equipment used \nmay differ depending upon many variables such as the type of vascular \nterritory involved (venous, arterial, small vessels, large vessels), clinical setting \n(elective or emergent procedure), and type of underlying disease to be treated \n(e.g. tumor embolisation, acute haemorrhage, vascular malformation, arterio-\nvenous fistula, etc). Pre-procedural imagi ng and planning are essential for \nmost embolisation procedures and intra-procedural navigation can be done \nwith fluoroscopy, DSA, and new 3D-techniques. With proper imaging workup \nprior to embolisation procedure time, radiation dose and contrast load can be \nsignificantly reduced. Embolisation material s can be roughly divided into liquid \nagents (alcohol, glue, polymers), particulate agents (PVA, calibrate micro-\nspheres, drug-eluting beads) and coils (detachable, non-detachable) and plugs \n(Amplatzer®-plugs). Plugs and coils are deployed at the exact site of \ndestination and usually easy and safe to use. Particles and liquid agents reach \ntheir site of destination by flow guidan ce and can be more difficult and \nunpredictable in their use. Complications include puncture-site complications \n(thrombosis, dissection, haematoma), systemic complications (contrast-\ninduced nephropathy, allergic reacti ons) and specific embolisation-related \ncomplications (non-target organ embolisation, end-organ ischaemia, post-\nembolisation syndrome). When used with expertise and proper experience, \nmost types of embolisation have good results with acceptable complication \nrates.  \nLearning Objectives:\n1. To understand the basic concepts and indications for embolisation. \n2. To learn about the practical aspect of embolisation, the techniques of \nendovascular navigation and the deployment of embolisation products. \n3. To learn about results and complications. \n16:00 - 17:30 Room C  \nGI Tract  \nRC 1901a  \nFrom my workstation:  \ndifficult cases on review  \nA-572 16:00 \nChairman's introduction  \nA. Maier; Vienna/AT (andrea.maier@meduniwien.ac.at) \nAlthough there has been advancement in im aging techniques, several pitfalls \nin the assessment of diseases of the pancreas, small bowel and rectum \nremain. The differentiation and the correct characterisation of tumours and \ninflammatory disease in some cases may be difficult. Also, atypical \npresentation of common tumours or uncommon tumours persists and is a \nchallenge. Problematic situations are constantly represented as intestinal \nbleeding and unexpected findings. In this session, we point out the procedure \nof the best imaging modality and protocols of challenging cases.  \nA-573 16:05 \nA. Pancreas  \nC. Triantopoulou; Athens/GR (ctriantopoulou@gmail.com) \nPancreatic imaging and interpretation of focal lesions remains a challenging \nissue. Despite the advances in imaging techniques and the dedicated protocols \nthat are now in use, a possibility for pitfalls remains. These pitfalls are related \neither to the inability of the early recognition of a lesion, or to the wrong \ncharacterisation of a \"mass\". Both pitfalls are of great importance, taking into \naccount the lethal pancreatic cancer and the possible complications that may \nfollow an unnecessary pancreatic surgery. There are many variants of the \npancreatic parenchyma, the ducts or even vessels, and deep knowledge of the \npancreatic anatomy and embryology is needed, to be able to recognise these \nvariations in imaging. A pancreatic variant may not only be misinterpreted as a \nsevere pancreatic disease (e.g. ectopic spleen vs neuroendocrine tumour), but \nmay also be the underlying cause of pancreatic inflammatory lesions (e.g. \nectopic pancreas on the duodenal wall causing groove pancreatitis). Other \npitfalls are related to the atypical presentation of a common lesion (e.g. \nisoattenuating pancreatic adenocarcinoma), the presence of uncommon \ntumours, diffuse or multifocal diseases, the co-existence of two different \nentities and the heterogeneous or overlapping appearance of cystic lesions. In \nany challenging case, a focused methodology should be applied and the \ndiagnostic procedure based on predefined imaging parameters, taking also into \nconsideration the clinical and laboratory findings. Excluding pancreatic cancer \nshould be the first goal and every attempt should be made to differentiate \nbetween surgical and non-surgical cases.  \nLearning Objectives:\n1. To appreciate the challenging variants in pancreatic anatomy. \n2. To learn about the most important pitfalls in pancreatic imaging. \n3. To understand the management of these challenging cases. \nA-574 16:28 \nB. Small bowel  \nE. Biscaldi; Genoa/IT (ennio.biscaldi@gmail.com) \nEndoscopy is the gold standard in small bowel diseases, but it is a challenging \ntechnique: the PillCam is a commonly used tool and multidetector CT is a \ndiffuse investigation technique. CT enteroclysis/enterography is a worldwide \ntool in intestinal exploration. Throughout the investigation of the small bowel, \nmorphologic anomalies or embryonal development defects may be present \n(Meckel's diverticulum, duplications of intestinal tracts). Artefacts may be \ndetermined and there may be misunderstanding. MDCT is the first tool in \nemergency diagnosis; imaging pitfalls are possible. Unsuspected diseases \nmay be revealed: we will see a case of GIST in a patient affected by intestinal \nbleeding of an obscure origin. CT enteroclysis may find unknown or \nunsuspected diseases: correct technical parameters have to be respected, as \nartefacts may be derived from an improper acquisition technique, such as a \nlimited distension or poor intravenous enhancement. In follow-up, MR is \npreferred to investigate the intestine, mainly in the young population. \nUnexpected findings may be due to rare pathology: we met a case of \nendometriosis, with ambiguous presentations; patients affected by autoimmune \npathologies (pyoderma gangrenosum or lupus erythematosus), with unknown \ninflammatory intestinal chronic diseas es. In oncology, PET-CT imaging is the \nmain diagnostic tool, but there are abdominal pitfalls that limit its effectiveness \n(intestinal hot spots, artefacts from peristalsis): the small bowel may frequently \nobstruct an easy diagnosis. In case of emergency, if the radiological diagnosis \nis not clear, the surgeon determines the management of the patient. In case of \na defective study technique, a correct examination may be repeated. \nEndoscopy or PillCam may help to detect mucosal lesions invisible at CT.  \nLearning Objectives:\n1. To learn about the normal anatomy and normal variants. \n2. To learn about the most important pitfalls in imaging assessment of small \nbowel lesions. \n3. To understand the management of these challenging cases. \nA-575 16:51 \nC. Rectum  \nD.M. Lambregts; Maastricht/NL (d.lambregts@mumc.nl) \nMRI plays a key role in the assessment of disease of the rectum and in \nparticular for the staging (and restaging) of rectal cancer. In this session, the \nrelevant MR anatomy of the rectum will be discussed. Furthermore, the \nstrengths and weaknesses of MRI in the assessment of rectal cancer during \nprimary staging and restaging after chemoradiotherapy will be highlighted \nusing various rectal cancer cases. Finally, we will discuss some rare tumours \nof the rectum (including GIST and carcinoid).  \nLearning Objectives:\n1. To learn about normal rectal anatomy and normal variants. \n2. To learn about the most important pitfalls in imaging assessment of rectal \ncancer or rare tumours of the rectum. \n3. To understand the management of these challenging cases. \nPanel discussion:  \nWhat can we learn from challenging cases?  \n17:14\n\nA B C D E F G S127  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\n16:00 - 17:30 Room D  \nChest  \nRC 1904  \nTake a deep breath and hold:  \nwhy and why not  \nA-576 16:00 \nChairman's introduction  \nP.A. Grenier; Paris/FR (philippe.grenier@psl.aphp.fr) \nOptimisation of CT and MR techniques has provided new challenges for \nimaging in the assessment of airway and lung diseases. Phenotypic \nabnormalities which can be recognised on visual and quantitative evaluation of \nCT images in COPD patients may improve the diagnostic accuracy, help \noptimise treatment and provide a framework for clinical trials. Although \nexpiratory CT helps assess air trappi ng due to small airway obstruction and \nexcessive dynamic collapse of large airways, potential tricks in technique and \ninterpretation of CT images must be known. Owing to multiple and successive \nimprovements over years, functional and morphologic evaluation of the lung \nusing MRI has become reality for clinical practice. Already regarded as a \nfavoured cross-sectional imaging in paedi atric chest radiology, MRI of the lung \nis gaining new indications also in lung diseases occurring in adults.  \nA-577 16:05 \nA. New insights into COPD on HRCT  \nN. Sverzellati; Parma/IT (nicolasve@tiscali.it) \nThe potential for high-resolution computed tomography (HRCT) to uncover \nseveral morphological subtypes that come under the umbrella term chronic \nobstructive pulmonary disease (COPD) is now more familiar to both \nradiologists and specialist respiratory physicians. A complete approach to the \nclassification of COPD would ideally assimilate several parameters through a \ncombined visual-quantitative HRCT analysis. The insight that some subjects \ngiven the label of COPD have \"pure\" airways diseases or emphysema can be \nreadily provided by a simple visual evaluation. The subtypes - centrilobular, \npanlobular, and paraseptal emphysema - can be reliably distinguished on \nHRCT images. The visual assessment of bronchial abnormalities and \naccompanying smoking-related interstitial  lung disease may also complete the \nphenotypic classification of COPD. Furthermore, it is now possible to \nobjectively quantify the global ex tent of emphysema, gas-trapping, and \nbronchial metrics by two types of softwares which are now increasingly \navailable on latest CT workstations.  \nLearning Objectives:\n1. To learn about the classification of COPD. \n2. To appreciate the role of HRCT in the classification of COPD. \n3. To become familiar with different methods of analysis of HRCT in COPD. \nA-578 16:28 \nB. Using inspiratory and expiratory CT  \nA. Devaraj; London/UK \nThis presentation will examine the role of expiratory CT in the diagnosis of \nsmall and large airways diseases. Small airways disease or air trapping may \nbe a feature of asthma, COPD and hypersensitivity pneumonitis, and is \ntypically characterised by a mosaic attenuation pattern on CT. \nTracheobronchomalacia and excessive dynamic airway collapse (EDAC) are \nlarge airways conditions that may be recognised by tracheal narrowing on \ninspiratory and/or expiratory CT. The typi cal clinical and CT manifestations of \nthese diseases will be reviewed. Additionally, a number of important caveats \nwith regard to CT in small and large airways disease will be discussed: 1) the \ncomparative strengths and limitations of CT, bronchoscopy and lung function \ntesting in making the diagnosis; 2) the overlap in appearances that exists \nbetween diseased and healthy individuals; 3) the variability in definitions of \nconditions such as tracheobronchomalaci a. The optimal CT technique for \nimaging of airways disease, including the role of dynamic expiratory CT, will \nalso be reviewed.  \nLearning Objectives:\n1. To learn when inspiratory and expiratory CT may be of value in patients with \nlung disease. \n2. To become familiar with different diseases and their appearances on \ninspiratory and expiratory CT. \nA-579 16:51 \nC. Pulmonary disease assessment with MRI  \nH.-U. Kauczor; Heidelberg/DE (Hans-Ulrich.Kauczor@med.uni-heidelberg.de) \nFor routine clinical applications, a standardised MRI protocol has been widely \nimplemented. It addresses the major challenges of MRI of the lung, i.e. low \nproton density, susceptibility artefacts as well as respiratory and cardiac \nmotion. Beyond visualisation of lung morphology, which is done in an \ninspiratory breath-hold, functional imaging has become an integral part of the \nroutine protocols: perfusion, blood flow , ventilation, respiratory motion, \ndiffusion. For perfusion imaging, inspiratory or expiratory scans can be used, \nblood flow measurement should be performed during shallow breathing, and \nventilation and diffusion are mainly assessed in inspiration. Respiratory motion \nis best assessed by dynamic image acquisitions. Continuous breathing can \nalso be combined with triggering or navigators to improve image quality or \nderive functional maps. MRI is recomm ended as the first-line cross-sectional \nimaging modality in paediatric chest radiol ogy, including cystic fibrosis, \ncomplicated pneumonia, any pulmonary or cardiovascular anomaly, as well as \nthe assessment of mediastinal masses in children and adults. MRI is also \nchallenging PET/CT in the staging of lung cancer (TNM) as well as CT and \nechocardiography in the assessment of pulmonary arterial hypertension. MRI - \neven without contrast - is an alternative in the diagnosis of acute pulmonary \nembolism if iodinated contrast medium is contraindicated or in pregnant \nwomen. MRI should also be used in complicated pneumonia, e.g. in \nimmunocompromised patients as well as for the functional assessment of \nchronic obstructive pulmonary disease (COPD) or severe asthma. The role of \nMRI in interstitial lung disease stills needs to be determined.  \nLearning Objectives:\n1. To learn about different MRI techniques used to assess pulmonary disease. \n2. To appreciate when MRI may be of value in patients with pulmonary \ndisease. \nAuthor Disclosure:\n H.-U. Kauczor: Equipment Support Recipient; Siemens, Philips. Investigator; \nBoehringer. Speaker; Siemens, Bracco, Bayer, Boehringer, Novartis. \nPanel discussion:  \nCorrelating imaging with lung function and pulmonary  \ndisease genotypes  \n17:14\n16:00 - 17:30 Board Room B  \nPaediatric  \nRC 1912  \nImaging the head and skull base  \nModerator:  \nJ.F. Schneider; Basle/CH \nA-580 16:00 \nA. Faciocraniosynostoses revisited  \nF. Di Rocco; Paris/FR\nUnlike the simple forms of cranisynostosis whose modalities and timing of \nsurgical correction are well established, the management of \nfaciocraniosynostoses requires a multispecialistic and repeated evaluation of \nthe single patients. Their evolution, in fact, depends on the specific genetic \nanomalies but also on the phenotype, which can vary in time, of their clinical \nexpression which may lead to different degrees in severity of the associated \nfunctional disturbances (CSF dynamics impai rment, visual deficits, respiratory \nanomalies, etc). Consequently these conditions may require several surgical \nsteps the timing of which are dictated by the exact clinical diagnosis and the \nevaluation of the functional status at different ages. Current management of \nfaciocraniostenoses is thus based not only on the radiological studies but also \non the functional assessment of the brain function (e.g. MRI imaging studies, \nmetabolic and cerebral blood circulation investigations, respiratory pathways \nvolume evaluation, sleep recording). Today's surgical multidisciplinary \nmanagement may benefit a large variety of techniques which extend from free \nbone cranioplasty with intraoperative active fixed expansion to more dynamic \nand less invasive methods which exploi t the physiological brain expansion in \ninfants or the gradual cranial vault expansion mechanically stimulated by \nsprings or distractors. In the present report, we will review the decision making \nprocess and the rationale on which, at the Necker-Enfants Malades, we base \nthe use of the currently available techniques for skull expansion and correction \nof cranial malformations according to the accurate dynamic radiological and \nfunctional evaluation at different stages of the disease.\nLearning Objectives:\n1. To learn about the imaging patterns of faciocraniosynostoses. \n2. To learn how and when to image. \n3. To become familiar with associated brain anomalies. \n\nA B C D E F G S128  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-581 16:30 \nB. All about the paediatric pituitary gland  \nM.I. Argyropoulou; Ioannina/GR (margyrop@cc.uoi.gr) \nMR is the imaging modality of choice for the assessment of the pituitary gland \n(PG) and the hypothalamus. The normal adenohypophysis is bright during the \nfirst two months of life and appears isosignal to the brain parenchyma \nafterwards. The neurohypophysis is bright, provided that the child is well \nhydrated. The PG height decreases during the first year of life and then \nincreases until puberty. Adenohypophyseal deficiency has been associated \nwith a small pituitary size, an ectopic neurohypophysis, a hypoplastic or absent \npituitary stalk, hypothalamic gliomas, craniopharyngiomas and iron overload \nstates. Precocious puberty may be idiopathic, but it has also has been \nassociated with hypothalamic hamartomas, craniopharyngiomas and \nhydrocephalus. Diabetes insipidus may be secondary to histiocytosis X, \ngerminomas and trauma causing pituitary stalk interruption. The hypothalamo-\npituitary axis is evaluated by using  sagittal and coronal T1-weighted images \nwithout and with contrast administration. Dynamic contrast enhancement may \nbe useful in the evaluation of disord ers responsible of diabetes insipidus. \nMagnetisation transfer imaging may be useful in the evaluation of pituitary \ndeficiencies or precocious puberty.  \nLearning Objectives:\n1. To become familiar with age-related changes of the normal pituitary gland. \n2. To learn about congenital and acquired pathology of the hypothalamo-\npituitary axis. \n3. To understand the pathophysiologic substrate of different imaging patterns. \nA-582 17:00 \nC. Imaging of the orbit: the globe and the lachrymal gland  \nP.C. Maly Sundgren; Lund/SE (Pia.Sundgren@med.lu.se) \nFamiliarity with orbital and ocular anatomy is crucial to the understanding of \ndisease processes of the orbit. Lesions of  the orbit may be divided into those \nwhich are intraocular and those which are extraocular. The underlying \naetiology and geneses of many different lesions that can occur in the orbits \nvary depending on the location of the lesions and sometimes on additional \nnonorbital conditions. CT and MRI play cruci al roles in the evaluation of orbital \npathology where often MRI still is a complement to CT examination in the \nevaluation of orbital lesions Familiari ty with the radiologic appearance of \ncommon orbital lesions is important, as many of these lesions will not be seen \non physical examination. After a very brief anatomic overview, most of this \nlecture will focus on the more common benign and malignant lesions as well as \ndifferential diagnosis involving the orbi t and lachrymal gland in both the \npaediatric and adult population. The lecture will also present suggested \nimaging protocol and standard of care with respect to imaging.  \nLearning Objectives:\n1. To understand the embryology and imaging findings of the most common \nmalformations. \n2. To learn about space-occupying lesi ons and the differential diagnosis of \ntumours and inflammatory conditions. \n3. To be aware of the role of conventional and advanced MR sequences in the \ndiagnostic approach to lesions in the orbit. \n16:00 - 17:30 Room E1  \nMusculoskeletal  \nRC 1910  \nThe hand and wrist  \nModerator:  \nS. Bianchi; Geneva/CH \nA-583 16:00 \nA. Patterns of injury  \nA. Navas Canete; Leiden/NL (a.navas_canete@lumc.nl) \nInjury to the wrist and hand is an important clinical problem. First, such injury is \nrelatively common. Second, the spectrum of abnormalities is complicated. The \npurpose of this presentation will be to learn more about the imaging \nappearances of soft tissue and osteoarticular injury of the wrist and hand using \nmultiple imaging techniques. Emphasis will be placed upon pathomechanics \nand characterisation of greater and lesser arc injury patterns of the wrist. The \nvarious posttraumatic instability patterns of the wrist will be also discussed.  \nLearning Objectives:\n1. To learn more about the imaging appearances of soft tissue and \nosteoarticular injury. \n2. To become familiar with the patterns of bone and soft tissue injury in the \nhand and wrist. \nA-584 16:30 \nB. Inflammatory disorders  \nH. Guerini, J.-L. Drapé; Paris/FR (henri.guerini@gmail.com) \nRheumatoid arthritis (RA), psoriatic arthritis (PsA) and other inflammatory \ndisease can be diagnosed and sometimes differentiated in the early stages of \nthe disease on the basis of MRI and/or PDUS features of the hand and wrist. \nRheumatoid arthritis (RA) activity is cl osely correlated with inflammation. The \nsynovial membrane is the principal site of inflammation in which the \ninflammatory process enhances capillary perfusion and permeability. Doppler \nultrasonography (DUS), using the amount of colour pixels in the region of \ninterest, and dynamic magnetic resonance imaging (DE-MRI) are both able to \ndetect this inflammation in the wrist and hand. Although these techniques are \nboth capable of monitoring synovium inflammation modifications after RA \ntreatment, PDUS has become an essential tool for RA joint monitoring in \nroutine practice in view of its sensitivity in the detection of synovitis, feasibility \nin outpatient clinics, and low cost.  \nLearning Objectives:\n1. To learn more about the imaging appearances of soft tissue and \nosteoarticular inflammation. \n2. To become familiar with imaging findings of specific inflammatory conditions. \nA-585 17:00 \nC. Tumours and tumour-like lesions  \nE. Llopis1, V. Higueras2, E. Belloch1; 1Valencia/ES, 2Alzira/ES\n(ellopis@hospital-ribera.com) \nRadiological study of the wrist and hand is challenging due to its complex \nanatomy with many small structures and the number of normal bone and soft \ntissue variants that might mimic injuries. Moreover, many findings can be \nasymptomatic. Their knowledge is important to avoid misdiagnosis. During this \nlecture we will also review the role of the different imaging modalities, such as \nplain films for wrist alignment and bone structures as well as the important role \nof US and MR in differentiating tumour from tumour-like conditions. We will \nbecome familiar with some specific radiological findings that allow us to make \naccurate diagnoses of soft tissue and bone lesions.  \nLearning Objectives:\n1. To learn more about the spectrum of intra and para-articular soft tissue \ntumours, and soft tissue tumour-like lesions. \n2. To become familiar with US and MRI findings of specific soft tissue lesions. \n16:00 - 17:30 Room E2  \nOncologic Imaging  \nRC 1916  \nManaging incidental findings in cancer \npatients  \nA-586 16:00 \nChairman's introduction  \nC. Pfannenberg; Tübingen/DE (christina.pfannenberg@med.uni-tuebingen.de) \nWith recent advances in cross-sectional imaging, the frequency of detecting \n\"incidental findings\" has markedly increased. Incidental findings \n(=incidentaloma) are defined as unexpected, asymptomatic abnormalities \ndetected by imaging performed for an unrelated reason. These incidentalomas \nhave created a management dilemma for both radiologists and clinicians, \nparticularly in the cancer patient in whom any mass warrants further \nevaluation. Discovery of incidental findings often leads to a cascade of \nadditional tests that is costly, provokes anxiety and exposes patients to the risk \nof unnecessary radiation and intervention. The workup of incidentalomas \nvaries widely by physicians, and stra tegies for optimising patient management \nare only beginning to emerge. In this course, guidelines concerning a rational \napproach to some of the more common incidental abnormalities in cancer \npatients are presented. Basic principles and tools for interpretation of incidental \nfindings, common pitfalls and protocol i ssues regarding the differentiation of \nbenign and malignant lesions as well as treatment-induced abnormalities will \nbe addressed with a focus on the liver, lung and skeletal system. At the end of \nthe session, the speakers will discuss the role of functional imaging techniques \nfor characterisation of incidental lesions.  \nSession Objectives: \n1. To become familiar with basic principles and common pitfalls in \ninterpretation of incidental findings in the lung, abdomen and skeletal system. \n2. To learn how functional imaging (DWI, PET/CT, BS) can help in lesion \ncharacterisation. \n3. To provide attendees with clear and practical messages for the management \nof the most common incidental findings in cancer patients. \n\nA B C D E F G S129  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-587 16:05 \nA. Abdomen: common pitfalls and protocol issues  \nA. Ba-Ssalamah; Vienna/AT (ahmed.ba-ssalamah@meduniwien.ac.at) \nAn incidentaloma is quite a frequent diagnosis in medicine, in general, and in \nradiology, in particular. By definition, an incidentaloma is an abnormality or a \ntumour found by coincidence without clinical symptoms or suspicion. These \nincidental findings have long posed challenges to physicians, and particularly \nto radiologists as well as health-care provi ders due to the resulting high costs. \nThe scope and scale of these challenges have increased with the introduction \nof new technologies, in particular cross-sectional imaging, such as MDCT and \nMRI using sub-millimetre thin slices. Incidentalomas still cause a management \ndilemma for clinicians, radiologists and even for the patients themselves. This \ndilemma is particularly pertinent to oncology patients. Therefore, a precise \nknowledge of the broad spectrum of incidental findings is crucial. Based on this \nknowledge, we can choose the appropriate radiologic examination that will \nprovide a confident diagnosis. This way, needless uncertainty, for both the \npatient and the physician in charge, is avoided. Furthermore, invasive \nprocedures, such as biopsies, with the potential for complications, as well as \ncost-intensive follow-up examinations, can be reduced. Furthermore, MRI is \nusually used to detect the side effects of chemotherapy of the liver. Simple \nsteatosis is usually reversible, unle ss the liver receives a 'second hit' of \ndamage from other causes leading to other manifestations, including \nchemotherapy-associated steatosis, sinusoidal obstructive syndrome, nodular \nregenerative hyperplasia, veno-occlusive disease, peliosis, pseudo-cirrhosis, \nand sclerosing cholangitis largely due to microvascular injury. Finally, the \neffects of chemotherapy on peritoneal and mesenteric structures after \nperforming intraperitoneal chemotherapy will be discussed.  \nLearning Objectives:\n1. To become familar with the most common benign lesions and pseudo-\nlesions of the liver, the adrenal glands, and the pancreas. \n2. To understand the CT and MRI characteristics by which the above-\nmentioned lesions and malignant diseases can be distinguished. \n3. To learn how the liver is generally affected by chemotherapy and how to \nmake a correct assessment. \n4. To become familiar with the effects of chemotherapy on peritoneal and \nmesenterial structures. \nA-588 16:28 \nB. Chest: CT follow-up and advanced techniques  \nA.A. Bankier; Boston, MA/US (abankier@bidmc.harvard.edu) \nThis presentation will discuss the complex topic of incidental findings in \nthoracic imaging of oncological patients. Incidental findings will be presented \nwith respect to their respective organs and anatomical regions. The \npresentation will emphasise the clinical relevancy of the findings as well as the \nspecific of risk estimation in oncological  patients. Finally, the presentation will \ndiscuss the usefulness (or lack thereof) of current management guidelines for \nincidental findings, as designed for the general population. Illustrative clinical \nscenarios will be discussed.  \nLearning Objectives:\n1. To become familiar with the CT characteristics of the most common benign \nand inflammatory/infectious lung lesions, as well as treatment-induced \nabnormalities. \n2. To learn how to distinguish signs of congestive heart failure from tumour \nspread. \n3. To learn how to distinguish benign parenchymal consolidations from \nmalignant pulmonary nodules. \n4. To become familiar with the criteria of the Fleischner society for the follow-up \nof indeterminate pulmonary nodules in cancer patients. \n5. To understand the indications for, and the limitations of PET for the \ncharacterisation of pulmonary nodules. \nAuthor Disclosure:\n A.A. Bankier: Author; Elsevier. Consultant; Olympus. Grant Recipient; NIH. \nSpeaker; ATS. \nA-589 16:51 \nC. Skeletal system: is MRI sufficient?  \nF.E. Lecouvet; Brussels/BE (frederic.lecouvet@uclouvain.be) \nRadiographs and CT often detect incidental observations in bones, \ncorresponding either to normal variants or benign conditions, which require \nadditional imaging to rule out malignant conditions. MRI most often provides \nnonambiguous explanation for these observations. Beside this, MRI, targeting \neither the whole body or only the axia l skeleton, often including diffusion-\nweighted (DWI) sequences, is increasingly used for bone tumour detection in \nmany \"osteophilic\" cancers and haematologic malignancies, without need for \ncontrast material injection and without i rradiation, with unparallelled sensitivity \nto bone lesions. An important advantage and also a challenge for \nmusculoskeletal radiologists are the all organ screening capabilities of DWI, \ndemanding careful study of the huge information provided and knowledge \nextending far beyond bones in terms of organs and metastatic spread of \ndifferent cancers. A second major advantage is its ability to detect lesion \nchanges under therapy. However, benign lesions and non-neoplastic \nconditions, as well as artefacts may also lead to confusing observations on \nMRI, and particularly on DWI. Anatomical MR sequences as well as other \nimaging modalities are of utmost help to recognise these pitfalls. Whole body \nMRI including DWI sequences has to position itself among other diagnostic \ntools, bone scan,  SPECT, and especially PET with its variety of tracers, in the \ncurrently evolving strategy of bone screening techniques, which will most likely \nvary according to the primary cancer.  \nLearning Objectives:\n1. To present most frequent x-ray and CT pseudo lesions and benign \nconditions and show how MRI often enables straightforward interpretation of \nthese abormalities. \n2. To highlight the strengths of MRI with diffusion weighted imaging (DWi) for \nmalignant lesion detection and characterisation within bones, but also beyond \nbones. \n3. To highlight the typical appearance of malignant lesions on projectional and \ncross-sectional imaging. \n4. To learn to differentiate these lesions from normal marrow variations, stress \nlesions, bony pseudo-lesions and other benign conditions, and to become \nfamiliar with treatment induced changes within lesions and their environment. \n5. To situate MRI amongst other functional imaging techniques (PET, SPECT, \n\u0002). \nPanel discussion:  \nThe role of functional imaging techniques in lesion  \ncharacterisation  \n17:14\n16:00 - 17:30 Room F1  \nAbdominal Viscera  \nRC 1901b  \nColorectal cancer liver metastases: \nassessing tumour response  \nA-590 16:00 \nChairman's introduction  \nP.R. Ros; Cleveland, OH/US (Pablo.Ros@UHhospitals.org) \nColorectal cancer is the 3 rd most commonly diagnosed cancer in the world with \n60% of cases diagnosed in the developed world. With an estimated 1.3 million \nnew cases clinically diagnosed and over 600,000 people killed worldwide by \nthis disease on an annual basis, colorectal cancer is a true public health \nconcern. Survival of colorectal cancer is directly related to the extent of disease \nand specifically presence of liver metastases. Imaging plays a key role in the \ninitial staging of colorectal cancer and is the gold standard in evaluating extra \ncolonic disease, primarily liver metast ases. Imaging is also widely used for \ntherapy monitoring and staging. CT, MRI, PET/CT and PET/MRI are the key \nimaging modalities. In addition, tumour response therapy assessed with \nmorphological and functio nal biomarkers is increasingly used by advanced \ngastrointestinal oncologic programs. Furthermore, image-guided therapy is \nwidely used for patients with unresectable lesions. Liver colorectal metastases \nwere the first liver metastases to be treated with image-guided ablation \ntechniques. A gamut of ablative techniques exists ranging from transarterial \nembolisation, radiofrequency ablation, highly intensified focused ultrasound, \nbrachitherapy etc. In short, diagnosing , characterising and finally assessing \ntumour response after neoadjuvant and image-guided therapy are all functions \nwhere imaging plays a pivotal role. This course is divided into three logical \nsegments dealing with current treatment options, morphological and finally \nfunctional biomarkers and it is followed by a panel discussion which includes \naudience participation.  \nAuthor Disclosure:\n P.R. Ros: Advisory Board; Philips Healthcare Radiology Medical Advisory \nNetwork, KLAS, Medical Advisory Board. Research/Grant Support; \nDepartmental Research support from Philips Healthcare, Siemens, Toshiba \nMedical Systems and SECTRA. \nA-591 16:05 \nA. Current treatment options  \nT.K. Helmberger; Munich/DE (Thomas.Helmberger@klinikum-muenchen.de) \nHepatic metastases in colorectal cancer may occur in 20% to 80% of the \ncases. Considering the general oncological (isolated hepatic tumour load; \nprognostic benefit), and technical (size, number, location of hepatic \nmetastases; expected hepatic functional reserve) framework, surgical resection \nis still considered to be the method of choice - even if this statement never had \n\nA B C D E F G S130  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nbeen verified by RTCs. Nevertheless, in clinical reality only 20-30% of patients \nwith liver metastases may qualify for resection. In consequence, the majority of \npatients need other or at least modified therapeutical pathways including \nadjuvant or neoadjuvant chemotherapy and more and more image-guided local \nablative therapies. The latter encompass chemo- (transarterial \nchemoperfusion/-embolisation), thermo- (radiofrequency-, laser-, microwave \nablation, high intensified focused ultrasound), and radio-ablative (radio \nembolisation, interstitial brachytherapy, etc). techniques. Particularly, thermal-\nablative techniques gained wide acceptance over the last years, since ample \nevidence could be presented showing that this method can be applied as \nprimary and also complementary therapies in resectable and non-resectable \nmetastatic disease. Furthermore, recent data confirm that in multimodality \ntherapy concepts, progression free survival and overall survival in patients with \nprimarily unresectable and with unfavourable prognosis is comparable to \nsurgery with 5-year survival rates more than 50%. Minimally invasive, image-\nguided therapies will not replace surgical resection; however, these therapy \nmodalities are eligible in a large number of cases and should be implemented \nconsequently in multimodality treatment regimens according to the \ninterdisciplinary consensus of oncologists, interventional radiologists, and \nsurgeons.  \nLearning Objectives:\n1. To understand the different scenarios in which liver metastases may present \nin relation to patient prognosis and therapeutic options. \n2. To understand the existing therapeutic approaches to liver metastases in \ndifferent scenarios. \nA-592 16:28 \nB. Morphological biomarkers  \nS. Skehan; Dublin/IE (s.skehan@st-vincents.ie) \nColorectal liver metastases are typically identified as low attenuation lesions on \nportal venous phase CT. Planning of optimal therapy depends on accurate \nlocalisation and characterisation of all focal liver lesions and this is best \nachieved with MRI, which should include diffusion-weighted imaging and use of \nhepatocyte-specific contrast medium. The typical MRI signature of colorectal \nmetastases includes low signal on T1w, moderately increased signal on T2w, \nirregular peripheral arterial phase enhancement with low signal on portal \nvenous phase, restricted diffusion and absent hepatocytes. Morphological \ntumour response can be assessed with either modality. Size-based systems \nfor assessing tumour response are widely applied, with RECIST 1.1 the most \nwidely used at present. RECIST 1.1 includes several modifications that make it \nmore user friendly than RECIST 1.1. More advanced morphological criteria \nhave been described for new targeted and molecular therapies, including \noverall attenuation, the tumour-liver interface and the appearance of the \nperipheral rim of enhancement. As hepatic surgeons become more aggressive \nin their approach to resection in patients with liver metastases, it is important to \nunderstand that disappearance or calci fication of liver metastases after \ntreatment does not necessarily equate to a complete pathological response. \nThe timing of imaging is therefore critical in assisting the surgeon to remove all \npreviously affected hepatic segments after chemotherapy.  \nLearning Objectives:\n1. To learn about the algorithm for detecting and characterising liver \nmetastases. \n2. To understand conventional imaging criteria for assessing tumour response. \n3. To learn about the rationale for monitoring patients after radical and \npalliative treatments. \nA-593 16:51 \nC. Functional biomarkers  \nD.-M. Koh; Sutton/UK \nConventional size measurement criteria remain the most widely used method \nto determine the response of colorectal liver metastases to treatment. \nHowever, tumour size reduction is assessed relatively late (e.g. 12 weeks after \ntreatment) and new targeted treatment may be effective without reducing \ntumour size. New functional imaging techniques can be applied to quantify \ndifferent aspects of tumour biology and to develop response, and predictive \nand prognostic biomarkers. We discuss the use of diffusion-weighted MR \nimaging, dynamic contrast-enhanced MR imaging and FDG-PET imaging in \nthe evaluation of treatment response in patients with colorectal liver \nmetastases.  \nLearning Objectives:\n1. To understand the different functional imaging techniques that can be used \nto monitor response to therapy including perfusion, diffusion MRI and PET/CT. \n2. To learn about efficient algorithms for assessing therapeutic response of \nliver metastases that influence prognosis. \n3. To understand how functional biomarkers are incorporated into multicentric \ntrials. \nPanel discussion:  \nThe \"vanishing\" lesions: what should you do  \n17:14\n16:00 - 17:30 Room F2  \nBreast  \nRC 1902  \nEmerging breast imaging technologies  \nModerator:  \nF. Pediconi; Rome/IT \nA-594 16:00 \nA. Digital breast tomosynthesis (DBT)  \nP. Skaane; Oslo/NO (PERSKA@ous-hf.no) \nDigital breast tomosynthesis (DBT) is a promising technique for breast imaging \nbased on a full-field digital mammography (FFDM) platform. The x-ray tube \nmoves through a proscribed arc, and several low-dose projection images are \nacquired. Images are reconstructed into a stack of 1 mm slices. The radiation \ndose is about the same or slightly higher than for FFDM. The most important \nadvantage of DBT is the elimination of superimposed tissue, which improves \ndetection of lesions otherwise hidden by dense breast parenchyma and \nreduces the interpretation problems caused by overlapping tissue. DBT is \nsuggested to improve sensitivity as well as specificity in women with dense \nbreast. DBT is superior to FFDM in tumour size assessment and for mass \nvisibility and cancer conspicuity. DBT is comparable to FFDM for evaluation of \nmicrocalcifications. DBT is superior fo r the detection of spiculated masses and \narchitectural distortion. The potential to improve sensitivity and specificity is of \ninterest for screening. An open question is whether DBT should be applied in \none or two views. Two-view DBT would mean a doubling of radiation dose, but \na solution is the implementation of synthetic 2D images reconstructed from the \n3D dataset of DBT. The synthesised images are created by summing and \nfiltering the stack of reconstructed DBT slices. Using synthetic 2D allows \n\"combo mode\" to be implemented in screening with the same radiation dose as \nfor conventional 2D. Results using DBT in breast cancer screening are very \npromising. Different study design of published studies may explain the \nvariations of results.  \nLearning Objectives:\n1. To become familiar with the technique of DBT. \n2. To understand the results of DBT in screening and diagnostics. \n3. To learn about the potential role of DBT in the breast radiological algorithm. \nAuthor Disclosure:\n P. Skaane: Equipment Support Recipient; Hologic, Inc. sponsored the Oslo \ntomo trial through the use of equipment. Research/Grant Support; Hologic, Inc. \nsponsored the Oslo tomo trial through financial support for additional overtime \ninterpretations. \nA-595 16:30 \nB. Multiparametric high-field MRI and more  \nP.A.T. Baltzer, K. Pinker-Domenig; Vienna/AT (patbaltzer@gmail.com) \nMagnetic resonance imaging of the breast provides a multitude of techniques \nfor detection of breast cancer and differentiation of benign from malignant \nlesions. In the last few years, significant improvements of scanner hardware \nand equipment in terms of coils as well as sequence software have been \nachieved. To date, multiparametric quantitative measurement of perfusion, \ndiffusion and tissue chemistry is possible at field strengths up to 7 Tesla. \nAlthough higher field strengths and improved sequence protocols provide \nhigher signal and allow faster imagi ng, specific technical issues have to be \nconsidered to avoid artefacts and pitfalls. This talk aims to demonstrate the \npossibilities and limitations of multiparametric and (ultra-)/high-field MRI. \nFurthermore, these new techniques are put into the broader clinical context to \ndetermine the potential value for breast le sion detection and differentiation.  \nLearning Objectives:\n1. To understand the management of breast lesions based on current MRI \napplications. \n2. To learn how to improve the specificity of breast MRI by adding new \ndeveloping techniques. \n3. To appreciate future developments and limitations. \nA-596 17:00 \nC. High-resolution radionuclide breast imaging (PEM and molecular \nimaging)  \nT. Wagner; London/UK (Thomas.Wagner@nhs.net) \nPositron emission mammography is a recently developed imaging device using \npositron emission technology. After injecti on of a positron-emitting radiotracer, \nthe radiation is detected by a dedicated high-resolution camera, providing high \nspatial resolution. Commercially available systems include cameras where the \nbreast is compressed and which display a 2D image similar in its layout to a \nmammogram and hanging breast devices where a 3D image similar in its \n\nA B C D E F G S131  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nlayout to MRI is produced. These devices have been compared to PET/CT and \nhave shown higher spatial resolution,  accuracy and sensitivity in detecting \nmalignant breast lesions. The most widely studied tracer in PET/CT and in \nPEM is fluorodeoxyglucose (FDG). FDG is a glucose analogue and has had a \nmajor impact on oncology imaging with PET/CT. Breast carcinomas \ndemonstrate increased glucose consumption and the intensity of the uptake \nhas been correlated with prognosis, hormonal receptor and HER2 status, Ki67 \nand nodal involvement. Current potential indications for PEM are detection and \ncharacterisation of breast lesions, local staging in patients with known breast \ncancer and baseline assessment prior to neoadjuvant chemotherapy. Future \ndevelopments of PEM will involve new tracers and fusion with other breast \nimaging modalities. Fluorothymidine is a proliferation tracer that seems \npromising in early assessment of response to chemotherapy. Fluoroestradiol \nhas the potential to image oestrogen receptor status in vivo. The possibility of \nPEM-guided biopsy is a very exciting development and has the potential to \nselect lesions with the highest intensity of uptake. Fusion with MRI, US and \nmammography will increase the diagnostic accuracy.  \nLearning Objectives:\n1. To become familiar with the current status: what is available and how does it \nwork? \n2. To understand the indications: local staging, distant staging, therapy \nmonitoring and limitations. \n3. To learn about future prospects: PET-MRI, targeted tracers. \n16:00 - 17:30 Room G/H  \nNeuro  \nRC 1911  \nRuling out disease:  \na radiologist's headache?  \nModerator:  \nP. Demaerel; Leuven/BE \nA-597 16:00 \nA. Vasculo-ischaemic lesions: inappropriate for age?  \nS. Haller; Geneva/CH (sven.haller@me.com) \nThe presentation will focus on two frequent findings on MRI with increasing \nincidence during ageing, notably \"unspecific\" hyperintense lesions on \nT2/FLAIR and cerebral mircobleeds (CMBs) on T2* or SWI images. Clinico-\nradiologic studies suggest that these T2/FLAIR lesions are associated with \nincreased risk of cognitive decline, stroke and death. The clinical relevance of \nthese lesions probably depends on periventricular versus deep white matter \nlocation. Radiologic-histopathologic studi es correspondingly indicate that the \ndegree of histopathologically confirmed demyelination also depends on the \nlocation of these T2/FLAIR lesions. Cerebral mircobleeds (CMBs) are punctate \nhypointense lesions on T2* or SWI images. While multiple CMBs are \nassociated with diseases such as cerebral amyloid angiopathy (CAA), clinico-\nradiologic studies demonstrate increased incidence of sporadic CMBs in mild \ncognitive impairment (MCI) and Alzheimer dementia, indicating a degrading \neffect of CMBs on cognition. On the other hand, radiologic-histopathologic \nstudies show that not all black spots on T2* or SWI correspond to CMBs. CMB \nmimics include micro-calcifications. The presentation will demonstrate typical \nmanifestations of these \"unspecific\" T2/FLAIR lesions and CMBs during ageing \nand provide tips for the interpretation of these lesions during daily clinical \nroutine.  \nLearning Objectives:\n1. To understand the aetiology and risk factors for small vessel disease. \n2. To appreciate the prognostic impact of extensive vascular white matter \nlesions. \n3. To learn how to interpret vascular white matter lesions according to age and \ndecide what is abnormal. \nA-598 16:30 \nB. Radiologically isolated syndrome: silent MS?  \nA. Rovira-Cañellas, C. Auger; Barcelona/ES (alex.rovira@idi-cat.org) \nWith the increasing use of MRI, it has become more common to discover \nincidental brain findings. These fi ndings may be non-specific or have some \nmorphological characteristics and geographical distribution highly suggestive of \na demyelinating disease. The term \"radiologically isolated syndrome\" (RIS) \nwas introduced by Okuda in 2009 to describe those asymptomatic patients with \nradiographic abnormalities highly suggestive of multiple sclerosis (MS). \nSometimes, these lesions may even meet the MRI criteria for dissemination in \nspace, which are currently used to predict future development or conversion to \nMS in patients presenting a clinically isolated syndrome (CIS). However, we \nmust not forget that these radiological criteria should be applied only when the \npatient had experienced any clinical manifestations suggestive of a \ndemyelinating disease. Therefore, what happens in those patients in whom we \nfound highly suggestive lesions but have never had symptoms? Due to lack of \nknowledge about the natural history or evolution of this new syndrome, clinical \nand therapeutic management of these patients is not well established, nor is \nthe risk of conversion to MS. Recent data, however, indicate that the presence \nof gadolinium-enhancing cervical cord and cortical lesions significantly \nincreases the risk of conversion to CIS or MS. All these data have improved \nthe characterisation of RIS subjects and in our understanding of risk factors for \ninitial symptom development.  \nLearning Objectives:\n1. To understand the 2010 revision of the McDonald criteria for MS and \nmeaning of RIS. \n2. To become aware of differential diagnosis of MS and red-flags in the \ndiagnostic process. \n3. To understand the use of gadolinium and spinal cord imaging in a diagnostic \nsetting. \nA-599 17:00 \nC. Incidental findings: what to report and what not to report?  \nA. van der Lugt; Rotterdam/NL (a.vanderlugt@erasmusmc.nl) \nIncidental findings on brain imagin g are defined as previously undetected \nabnormalities of potential clinical relevance that are unexpectedly discovered \nand unrelated to the purpose of the imaging. Incidental findings are \nincreasingly detected in clinical practice, with screening, and in the research \nsetting. Data on the prevalence of these abnormalities are scarce, the clinical \ncourse of the findings is often unknown, and the management of such lesions \nis not clear. The prevalence of incid ental findings can be expected to vary \ndepending on the purpose of the imaging exams. With improvements in \nimaging technology (higher field scanners,  new pulse sequences), the number \nof detected incidental findings will increase dramatically. Another important \npoint is the advent of imaging biomarkers. Advanced techniques for \npostprocessing and analysis, such as automated segmentation of brain \nstructures or voxel based morphometry, will lead to the discovery of imaging \nbiomarkers. Once the predictive value of these markers has been established, \nmost MRI studies of the brain, both in the clinical and research setting, will \nreveal information that might be relevant for the well-being of patients or \nparticipants. Although still incidental, these findings can unfortunately no longer \nbe considered unexpected. We will soon face large medical, ethical, and \npractical problems as a result of technical improvements. In this lecture, the \nmost important incidental findings and their prevalence will be reported. The \nmanagement of incidental findings in the clinical and research setting will be \ndiscussed. Finally, recommendations for follow-up will be provided.  \nLearning Objectives:\n1. To become familiar with the frequency of incidental findings on brain MRI. \n2. To understand the clinical relevance of incidental findings - can they cause \nheadache? \n3. To learn how to report incidental findings and when to recommend clinical or \nimaging follow-up. \nAuthor Disclosure:\n A. van der Lugt: Board Member; European Society of Magnetic Resonance \nin Medicine and Biology. Investigator; GE Healthcare. Speaker; GE \nHealthcare. \n16:00 - 17:30 Room N/O  \nHead and Neck  \nRC 1908  \nImaging laryngeal cancer  \nModerator:  \nB. Banko; Belgrade/RS \nA-600 16:00 \nA. What matters in staging laryngeal cancer  \nR. Maroldi; Brescia/IT (maroldi@med.unibs.it) \nThe primary assessment of laryngeal cancer is provided by endoscopy, which \nis accurate in delineating both the superficial extent and functional impairment. \nImaging techniques are recommended to grade submucosal invasion, local \nand distant spread. In the last few decades, open and endolaryngeal surgical \nprocedures as well highly sophisticated RT techniques have been developed to \ntreat the tumour while preserving critical laryngeal functions. For example, \nearly glottic tumours (Tis-T2) can be treated by endoscopic laser excision or \nRT. The integration of information acquired by endoscopy and imaging is \nessential for proper treatment planning. The radiologist has to know that the \nsite of origin (supraglottis vs glottis or subglottis) and lo cal extent (superficial \nand submucosal) are the key tumour-related factors in planning the type of \ntreatment. Submucosal invasion has a variable impact depending on the \n\nA B C D E F G S132  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nlocation of the primary tumour. The 5 key issues in glottic cancers include the \ninvasion of: the posterior paraglottic space, crico-arytenoid joint, and anterior \ncommissure and contralateral true vocal cord, and vertical spread towards \nsupra and/or subglottis, thyroid or cricoid cartilage. The 5 key issues in \nsupraglottic cancers encompass the invasion of: base of the tongue, pre-\nepiglottic space, piriform sinus, vertica l spread into glottis and subsequent \ncartilage invasion (observed exclusively in transglottic cancers). Function-\nsparing surgical techniques - as supracricoid laryngectomies - can be applied \nin advanced cancers when sparing of the posterior commissure, the ipsilateral \ncrico-arytenoid joint, the mucosa investing the upper cricoid and the outer \nperichondrium of the thyroid cartilage is demonstrated by endoscopic and \nimaging mapping.  \nLearning Objectives:\n1. To become familiar with the typical findings of T1-T4 laryngeal cancer. \n2. To learn about the patterns of local nodal involvement. \n3. To understand possible imaging pitfalls in staging. \nA-601 16:30 \nB. How to evaluate the post treatment larynx: clinical and histological \nalterations after initial treatment  \nP. Zbären; Berne/CH (peter.zbaeren@insel.ch) \nThe detection of recurrent laryngeal carcinoma is often challenging. To better \nappraise the expected findings after initial surgery of laryngeal cancer, the \nclassical partial laryngectomy and laser laryngeal surgery are briefly presented. \n(Chemo)radiotherapy has become an important treatment modality for \nlaryngeal carcinoma. The recurrence rate in T2-T4 laryngeal carcinoma is \nreported to be between 25% and 50%. The difficulty in differentiation between \nradiation reaction (such as oedema, fi brosis and soft tissue and cartilage \nnecrosis) and recurrent disease is discussed. A histologic study on whole-\norgan sections of 29 recurrent glottic carcinomas is also presented: recurrent \ndisease presents with different tumour spread than does a primary carcinoma, \nresulting in difficulties in estimating the extent of tumour recurrence. Currently, \nselected recurrences of early glottic carc inoma are, whenever possible, treated \nby larynx-preserving salvage surgery. In those cases, a precise evaluation of \nthe recurrent tumour extent is mandatory for planning larynx-preserving \nsalvage surgery. This is especially true in critical regions such as the pre-\nepiglottic space, infiltration into cartilage, contralateral tumour spread and \nsubglottic tumour extension. The accuracy of crT-classification is relatively low: \nmany patients with signs and symptoms suggesting tumour recurrence present \nwith post-radiotherapy changes; small tumor foci, often localised in the \nsubglottic region, are undetectable by imaging studies.  \nLearning Objectives:\n1. To appreciate the expected findings after surgery of laryngeal cancer. \n2. To become familiar with findings after non-surgical treatment. \n3. To know about the possible imaging pitfalls due to the histopatholgical \npatterns of disease recurrence. \nA-602 17:00 \nC. Can we rule out cancer recurrence?  \nF.A. Pameijer; Utrecht/NL (f.a.pameijer@umcutrecht.nl) \nTissue changes in the neck treated by surgery and/or radiotherapy (RT) make \nthe detection of residual or recurrent tum our more difficult. Clinical evaluation \nof the neck is also hampered by these changes. RT-induced fibrosis and post-\nsurgical scar tissue make palpation of the neck very difficult. Endoscopy is \nhampered by endolaryngeal oedema which can persist for many months post-\nRT. Therefore, any (non-invasive) method helping in the detection of \nrecurrence is welcome. Patients at ri sk for local failure after RT can be \nsuccessfully identified by a post-RT CT (or MR) study between 1 to 6 months \nafter RT. The optimal time point to perform such a 'baseline study' seems to be \nabout 3 to 4 months post-RT. Patients with indeterminate findings are \ncandidates for 'imaging surveillance'; i.e. follow-up imaging every 3 to 4 months \nup to a period of 2 years after RT. However, ongoing studies suggest that \nmetabolic imaging (FDG-PET) may detect local recurrences with a higher \naccuracy than 'conventional' anatomically based imaging techniques, such as \nCT and MR. CT and/or MR-findings in the treated neck are frequently \ninconclusive. At present, new techniques are available to detect recurrent \ncancer. PET-CT is widely applied in the post-treatment setting. Also, advanced \nMR-techniques such as diffusion weighted imaging (DWI) and dynamic \ncontrast-enhanced MR (DCE-MR) can be applied. Focusing on the larynx, the \nadvantages of these techniques as well as the limitations will be shown using \nimaging examples from daily practice.  \nLearning Objectives:\n1. To understand the limitations of clinical examination. \n2. To appreciate the value of different imaging techniques in the detection of \nrecurrence. \n3. To become familiar with the imaging findings of recurrent laryngeal cancer. \n16:00 - 17:30 Conf. Room M3  \nMolecular Imaging  \nRC 1906  \nMolecular imaging in oncology  \nModerator:  \nE.J. Rummeny; Munich/DE \nA-603 16:00 \nA. New PET-tracers for oncology  \nW. Weber; New York, NY/US \nDuring the last 10 years, several hundred new radiotracers for PET imaging of \ncancer have been developed and tested preclinically. These tracers are based \non proteins (e.g. antibodies and antibody  fragments), peptides (e.g. G protein-\ncoupled receptor ligands) or small molecules (e.g. radiolabelled protein kinase \ninhibitors or metabolic substrates). Using these radiotracers, the expression \nand function of a variety of proteins can be studied in patients, including for \nexample glutamine/glutamate metabolism, neutral amino acid transport, \nPSMA, GRPr, SSTr, CXCR4, folate and alpha-v beta-3 integrin expression. \nSome of these radiopharmaceuticals are potential companion diagnostics and \nmay allow selection of patients for treatment with radiopharmaceuticals or \ntargeted drug conjugates. Preclinical and initial clinical data are promising for \nseveral new radiotracers, but the key challenge is the clinical validation and \ndissemination of these compounds. Validation and dissemination have been \nhampered so far by regulatory hurdles as well as by the lack of standardised \ntrial designs for the validation of imaging agents and the lack of accepted and \nappropriate end points to prove clinical utility. Addressing these issues will be \ncritical for the future clinical use of PET and other molecular imaging \ntechnologies.  \nLearning Objectives:\n1. To learn about the new specific tracers that can be used in oncologic \npatients. \n2. To appreciate their potential impact on patient management. \n3. To understand their potential and limitations for practice. \nAuthor Disclosure:\n W. Weber: Advisory Board; Endocyte, MSD. Grant Recipient; Bayer, Philips. \nA-604 16:30 \nB. Potential of MRI for molecular imaging in oncology  \nF. Gallagher; Cambridge/UK (ferdia.gallagher@doctors.org.uk) \nImaging targets in cancer range from simple size measurements to more \nspecific biomarkers on functional, cellular, metabolic and molecular levels. As \nour understanding of basic tumour biology has advanced, techniques have \nbeen developed to exploit this informati on to produce increasingly specific \nmolecular imaging tools. The biodistribution of these molecular imaging probes \nshould be more specific in diagnosing and assessing cancer than the \nmorphological information acquired using anatomical imaging alone. This \nlecture will discuss current and emerging functional and molecular imaging \ntechniques using MRI and their applications in oncology. Functional measures \nof tumour blood flow and vascular permeability can be made using dynamic \ncontrast-enhanced MRI. Diffusion-weighted imaging is a surrogate for the \ncellular content of the tumour and emerging methods can be used to probe \nfeatures of the extracellular space such as tumour pH and stromal content. On \nthe molecular level, cell surface expression of specific proteins and enzyme \nactivity within the cell can be imaged; labelled probes have been developed \nwhich bind to these proteins and a new MR technique is being developed for \nassessing tumour glucose in a similar way to PET. Hyperpolarisation methods \nare emerging to overcome the major limitation of MR: low sensitivity. One such \napproach is dynamic nuclear polarisation, which can probe carbon metabolism \nnon-invasively in patients with cancer. Functional and molecular imaging \ntechniques with MRI will increasingly be used in radiology in conjunction with \nanatomical imaging methods to improve diagnosis and prognosis, target \nbiopsies, as well as predict and detect response to treatment.  \nLearning Objectives:\n1. To become familiar with the different approaches to molecular imaging with \nMRI. \n2. To understand the role of molecular imaging in oncology. \n3. To learn about emerging MRI techniques for molecular imaging. \nAuthor Disclosure:\n F. Gallagher: Research/Grant Support; GE Healthcare. \n\nA B C D E F G S133  \nMonday \n\u0011\u001e !\u0018\u001f\u0014\u0016\"\u0014!\u0017\u0001\u000e\u0016\"\u0015\u0014!\u001a\u001e\u001d\u0014\u001b\u0001\u0011\u001f\u001e\u0018\u001f\u0014\u001c\u001c\u0017\u0001\nA-605 17:00 \nC. Emerging molecular imaging techniques  \nF.M.A. Kiessling; Aachen/DE (fkiessling@ukaachen.de) \nWith MR-spectroscopy, diffusion-weighted imaging, PET- and SPECT-CT, as \nwell as PET-MRI, molecular imaging has already become part of clinical \nroutine diagnosis. Also, some contrast agents such as SPIO for MPS-labelling \nand scavenger-receptor binding gadolinium chelates are clinically applied for \nliver and lymph node imaging. However, there are still a number of highly \npromising novel tools that are expected to emerge clinically in the near future. \nIn this context, the first part of the talk will give an overview on how optical \nimaging basically works and which future clinical applications can be expected. \nIn this context, RAMAN spectroscopy, fluorescence optical reflectance \nimaging, fluorescence mediated tomography, photoacoustic imaging and \nCerenkov luminescence imaging will be addressed. The second part of the talk \nintroduces molecular ultrasound imaging as a safe and preclinically well-\nevaluated method. Besides the diagnosti c use of molecular ultrasound contrast \nagents, which have been already evaluated in clinical trials, the potential of this \nmethod also for theranostic purposes will be highlighted.  \nLearning Objectives:\n1. To become familiar with optical imaging techniques and probes. \n2. To learn about the potential of targeted US contrast agents. \n3. To learn about emerging hybrid imaging techniques. \n16:00 - 17:30 Board Room A  \nCardiac  \nRC 1903  \nPractical approach to cardiovascular risk \nstratification with CT and MRI  \nModerator:  \nG.I. Kirova-Nedialkova; Sofia/BG \nA-606 16:00 \nA. Modern views on value of coronary calcium scoring for risk \nassessment  \nA. Stadler; Vienna/AT (alfred.stadler@meduniwien.ac.at) \nThe assessment of the amount of arterial calcification with computed \ntomography is a standard method in the risk stratification of coronary heart \ndisease. Coronary calcium detection by CT has been shown to identify \natherosclerotic plaque and to quantitatively assess coronary calcium. Many \nstudies have demonstrated the association between the degree of coronary \ncalcium, the burden of atherosclerosis, and the risk for cardiovascular events \nassociated with coronary calcium. The CAC scoring can provide individual risk \nassessment and reclassify the low and particularly intermediate Framingham \nrisk cohort into lower- and higher-risk strata. The absence of CAC is associated \nwith a very low risk of future cardiovascular events, with modest incremental \nvalue of other diagnostic tests in this very low-risk group. The role of CAC in \nthe workup of symptomatic patients is under discussion and there is evidence \nthat the absence of CAC has a high negative predictive value for ruling out \nacute coronary syndrome. Although CAC measurement is highly standardised, \nsome technical aspects have to be considered and all possibilities of dose \nreductions utilised. This presentation will show the technical and \nepidemiological fundamentals of CA C scoring and discuss the clinical \napplications of the method.  \nLearning Objectives:\n1. To understand what kind of information calcium scoring can deliver and the \nappropriate indications. \n2. To become familiar with its role in an asymptomatic and in a symptomatic \npopulation. \n3. To learn about the current data and guidelines supporting its use in the \nassessment of cardiac risk. \nA-607 16:30 \nB. Prognostic value of coronary CTA  \nR. Vliegenthart; Groningen/NL (r.vliegenthart@umcg.nl) \nCoronary CTA has gained an important role in the evaluation of patients with \nchest pain, suspected of coronary artery disease (CAD). In comparison to \ninvasive coronary angiography, coronary CTA with \u0002 64-multidetector CT has \nan excellent sensitivity for coronary stenosis. Specificity for stenosis is less \nexcellent, but has improved with newer CT generations. The strongest impact \nof coronary CTA has been on the exclusion of stenosis in symptomatic patients \nat low-intermediate pre-test probability. In contrast to invasive angiography, \ncoronary CTA yields more information than just the severity of stenosis. \nCoronary CTA also allows determination of plaque types (calcified, non-\ncalcified, partly calcified) and quantification of the atherosclerotic plaque \nburden. Also, new developments point to the possibility to assess the \nhaemodynamic significance of stenosis based on CT density measurements in \nthe coronary arteries, or evaluation of myocardial perfusion. Thus, coronary \nCTA yields quantitative imaging biomarkers that could be used for risk \nstratification in the future. Recent studies have shown that whether or not a \npatient has stenosis and plaque, as well as the type and burden of plaque, \naffects the risk of myocardial infarction and mortality. Therefore, the impact of \ncoronary CTA imaging biomarkers reaches beyond the mere assessment of \nstenosis for symptomatic treatment and could potentially alter medical \nmanagement of patients for improvement of long-term prognosis.  \nLearning Objectives:\n1. To understand the accuracy of CTA in the diagnosis of coronary disease. \n2. To become familiar with the strengths and limitations of the various \nquantification techniques. \n3. To appreciate the prognostic value of CTA in coronary disease. \nAuthor Disclosure:\n R. Vliegenthart: Grant Recipient; Supported by a grant from the Netherlands \nOrganisation for Scientific Research. \nA-608 17:00 \nC. Added value of carotid and peripheral artery imaging for risk \nassessment  \nL. Natale; Rome/IT (lnatale@rm.unicatt.it) \nTechnical protocols optimisation of MRA and CTA of carotid and peripheral \narteries is crucial for image quality and to complete the analysis of both lumen \nand vessel wall. Furthermore, MRA protocol needs to be integrated with \ndedicated pulse sequences in order to obtain vessel wall imaging that is \nalready included in CTA datasets. New CT and MR scanners allow this \noptimisation in terms of radiation exposure, contrast media dose reduction and \nspatial resolution. All these parameters will be discussed for both techniques. \nAccording to international guidelines, non-invasive imaging indications will be \ndiscussed, with particular attention to high risk population (e.g.: diabetic \npatients). Some possible imaging biomarkers of plaque composition will be \ndiscussed.  \nLearning Objectives:\n1. To become familiar with optimal technical considerations for performing CTA \nand MRA of the carotid and peripheral arteries. \n2. To understand clinical indications for carotid and peripheral CTA and MRA. \n3. To discuss the role of CTA and MRA parameters including plaque imaging \nas biomarkers of cardiovascular disease.","source_license":"CC-BY-4.0","license_restricted":false}